Corrective Osteotomy for Ipsilateral Distal Clavicular and Coracoid Malunions

Malunion after double disruption injuries of the superior shoulder suspensory complex accompanied by shoulder pain and dysfunction has been reported infrequently. A 37-year-old man had a double disruption injury (fractures of the distal clavicle and the base of the coracoid process). Conservative treatment resulted in malunion. Twelve months after the injury, pain continued in the coracoclavicular interval, and there was only 125° forward shoulder elevation. Radiographs showed 50° inferior angulation of the distal clavicle and elongated base of the coracoid process. Corrective osteotomy was required; however, the concomitant malunion of the coracoid prevented correction of the deformity with osteotomy of the distal clavicle alone. Therefore, osteotomy of the coracoid was performed. Twelve months postoperatively, successful bone union resulted in loss of pain. Forward elevation had recovered to 160°. Distal clavicular fractures with concomitant coracoid fractures are often significantly displaced, which disrupts physiologic coupling of clavicular and scapular motion and limits forward elevation. In the case of such malunions, excessive movement at the clavicle-scapula junction during mobilization causes pain in the coracoclavicular interval. Correction of this deformity requires osteotomy of both the clavicular and coracoid malunions.