Arthroscopy-assisted technique restores
normal function of a patient's hand

A 71-year-old male with right side dominance had a severe fall and approached Nanavati Super Speciality Hospital with pain on the outstretched right hand and swelling with deformity in the right shoulder. X-rays of the right shoulder showed displaced fracture of the distal end of the clavicle - Neer’s type 5.

Arthroscopy-assisted coracoclavicular splinting was performed for the fracture of the distal end clavicle. With the patient

under anaesthesia , the surgery was performed in a beach chair position. Standard portals were used to perform diagnostic Glenohumeral Arthroscopy. Then the rotator interval was dissected, and the coracoid process was exposed. An accessory anterosuperior portal was created, and viewing was shifted to the same to have a better visual of the base of the coracoid.

The inferior surface of the base of coracoid was then cleared for accepting the coracoclavicular jig. A tunnel was then drilled with the jig from the medial fragment of the clavicle to the coracoid process, without opening the fracture site. Sutures were then passed through the tunnel and fixed on the superior surface of the medial fragment in a percutaneous fashion and inferior surface of the coracoid under arthroscopic guidance with endobuttons. The reduction was confirmed with an image intensifier. The portals and incisions were closed. The surgery was completed within 40 minutes.

A sling was worn for couple of weeks post surgery. Passive and active range of motion exercises were started as soon as the pain permitted. Heavy lifting and weight-bearing exercises were prohibited until there was adequate radiological evidence of fracture healing, which was at 6 weeks in this case. The patient achieved a functional status similar to the pre-injury level at approximately 3 months post surgery.

Dr. Yajuvendra Gawai

Dr. Yajuvendra Gawai
Consultant – Shoulder &
Knee Specialist, Arthroscopy Surgery & Sports
Orthopaedics & Joint
Nanavati Super Speciality
Hospital, Mumbai