Management of intraoperative coracoid fractures in the arthroscopic Latarjet procedure

A marked increase in the number of Latarjet procedures performed has been observed and, with that, a rise in the number of complications, with intraoperative coracoid fracture being reported as one of the most common complications, especially in the arthroscopic approach. There is a scarcity of studies reporting on these complications; thus, the techniques and results are unclear.

Retrospective case series of patients with intraoperative coracoid graft fractures during arthroscopic Latarjet performed between 2010 and 2023. In this report, we described a new coracoid graft fracture classification based on the location of the fracture relative to the screw's holes (type 1, through the distal hole; type 2, through the proximal hole [2A: partial, 2B: complete stable, 2C: complete unstable]; type 3, longitudinal splits through both holes [3A: symmetric fragments, 3B: asymmetric fragments]; and type 4, severely comminuted fractures) and proposed an algorithm approach to address intraoperative coracoid fractures during the arthroscopic Latarjet.

Twelve intraoperative coracoid graft fractures were identified, of which 3 were classified as type 3 (1 case treated with a stabilizing suture, 2 with an Eden-Hybinette procedure), 1 type 1 (treated with an interference screw), and the remaining 8 as type 2. Of those, the graft was secured with a stabilizing suture in 2 cases with a 2A fracture. In the remaining, a transporting suture was used for graft handling and fixation was obtained with 1 (4 cases) or 2 screws (2 cases). Immediate postoperative computed tomographic scan showed satisfactory position of the graft in all cases, including those revised with an Eden-Hybinette procedure. Satisfactory postoperative clinical and functional results were obtained. At 69.6 ± 40.8 months' mean follow-up, all patients had full range of movement and no instability. Postoperative scores were also satisfactory, with a median (range) Rowe, Western Ontario Shoulder Instability Index, and Subjective Shoulder Value scores of 80.8 (10-100), 571 (25-1345), and 80 (20-100), respectively. Six patients returned to sport at the same preoperative level. Eighty-three percent of patients were satisfied with their postoperative status.

The arthroscopic Latarjet technical difficulty and steep learning curve may lead to a high rate of intraoperative graft fractures. In the current study, we described 3 types of intraoperative coracoid graft fractures in 12 patients undergoing an arthroscopic Latarjet. We performed 6 different techniques that enabled maintaining stability with no revision surgery. Fractures with poor bone quality and instability may be better managed with an iliac crest bone grafting technique.