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.
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.
A sling was
worn for couple
started as soon
as the pain
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.