PMC8783312_01
preoperative imaging, A) AP X-rays; B) lateral X-rays; C) CT-scan coronal view; D) and sagittal view
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F1
Diagnosis assessment: the initial morphological assessment found a type 3 ACD and a displaced fracture of the CP at the coracoclavicular ligaments insertion with no breach to the lower coracoid cortex (Figure 1).
prototype representation of the fracture line (in red) and of the 3 lacings performed, A) AP view of the first lacing; B) AP view with representation of a "gull winged" node; C) and lateral view
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F2
The first "gull-winged" lacing between the 2 coracoclavicular ligaments is perpendicular to the fracture line, and the 2 other lacings are trans ligamentous (Figure 2).
A) post-operative X-rays on day 1, AP; B) and lateral view
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F3
Follow-up and outcomes: postoperatively the patient was immobilized in a shoulder brace for 6 weeks, passive range of motion was authorized immediately after surgery and X-rays control (Figure 3).
A) post-operative X-rays on day 45, AP; B) and lateral view
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F4
Acromioclavicular arthrorisis pins were removed at 6 weeks without any complications (Figure 4).
bilateral active mobility 3 months postoperatively, A) flexion; B) external rotation; C) internal rotation
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F5
The clinical examination (Figure 5) at 3 months found a constant score of 92/100 (active mobility 40/40, pain 15/15, daily activities 12/20, strength 25/25).
CT-scan views 3 months post operatively, A) coronal view; B) sagittal view
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F6
The imaging checkup at 3 months (X-rays and computerized tomography) showed a partially consolidated fracture with a satisfactory reduction associated with a bone callus allowing the resumption of sports activities (Figure 6).
three-dimensional reconstruction showing the reduction and the callus of the coracoid process at 6 months
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F7
At 6 months, bone consolidation was fully attained (Figure 7), and the patient had completely gone back to her previous professional and sport activities (constant score of 100/100).