Arthroscopy-Assisted Fixation of Combined Coracoid Fracture and Acromioclavicular Dislocation: A Minimalist Approach.

Abstract

Combined acromioclavicular dislocation and coracoid process fracture disrupts the superior shoulder suspensory complex, leading to shoulder instability that often requires surgical intervention. This rare injury, increasingly identified through advanced diagnostics, lacks consensus on the optimal treatment. We describe a minimalist arthroscopy-assisted technique using a single cannulated screw for simultaneous fixation of both injuries. The procedure involves lateral decubitus positioning, diagnostic arthroscopy with a 70° scope for fracture visualization and debridement, ACL drill guide-assisted pin insertion from the clavicle through fracture fragments, and screw placement confirmed by fluoroscopy. Postoperative care includes 8 weeks of sling immobilization followed by implant removal and progressive rehabilitation. This approach offers small incisions, reduced tissue irritation, and applicability to common fracture types (e.g., Ogawa type I with Rockwood type III, Ye type II). Advantages include technical feasibility with standard tools, while limitations include risks of stiffness, antirotation instability, and secondary surgery. This method addresses the drawbacks of open techniques but requires careful patient selection and further comparative studies for long-term validation.