Coracoid bone block fixation with cortical buttons: An alternative to screw fixation?

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomaterials Science

Background:

• Recurrent anterior shoulder instability often requires surgical intervention.
• Traditional screw fixation for bone block procedures carries risks of neurologic and hardware complications.
• Suture button fixation presents a novel approach for securing bone grafts.

Purpose of the Study:

• To evaluate the efficacy and safety of suture button fixation in Bristow and Latarjet bone block procedures.
• To compare bone union rates and complication profiles between suture button and screw fixation.
• To assess the predictability and reproducibility of cortical button fixation in shoulder stabilization.

Main Methods:

• Seventy patients with recurrent anterior shoulder instability underwent arthroscopic bone block procedures using suture button fixation.
• Patients were divided into two groups: 35 Bristow procedures (group A) and 35 Latarjet procedures (group B).
• Postoperative computed tomography (CT) imaging was used to assess bone graft union and positioning accuracy at 2 weeks and 6 months.

Main Results:

• The coracoid graft was accurately positioned in most cases (93% below equator, 94% tangential to glenoid).
• Overall bone healing was observed in 83% of patients, with higher bone union rates in the Latarjet group (91%) compared to the Bristow group (74%).
• No neurologic or hardware complications were reported, unlike those typically seen with screw fixation.

Conclusions:

• Suture button fixation is a safe and effective alternative to screw fixation for bone block procedures, achieving reliable bone union.
• The Latarjet procedure (lying position) demonstrated superior bone healing compared to the Bristow procedure (standing position).
• This fixation method effectively mitigates the complications commonly associated with screw fixation in shoulder stabilization surgeries.