Surgical Discussion

Patient positioning:  Initial posterior approach was performed with the patient in a prone position utilizing the traumatic wound for access. For the anterior approach, the patient was repositioned supine.

Anatomical surgical approach:  Posterior approach: Access through the traumatic wound along the scapular spine, exposing the supraspinatus fossa and spine fragment. Reduction of the lateralized supraspinatus fossa/spine fragment was achieved by medializing it to create a flexible hinge point at the medial border. The acromion was then reduced to the spine and fixed with a tension band plate. Anterior approach: Proximal deltopectoral incision with biceps tenotomy, subscapularis release, and arthrotomy to reduce the coracoid-glenoid fragment under direct visualization.

The surgeon noted that addressing each lesion was crucial for optimizing shoulder function. The sequence began with restoring scapular morphology via the posterior approach, followed by addressing the coracoid-glenoid fragment anteriorly. The intact coracoclavicular ligaments provided stability, allowing for accurate reduction of the acromioclavicular joint once the coracoid-glenoid was fixed.

Postoperative protocol:   Postoperative rehabilitation included immobilization in a shoulder sling for initial weeks, followed by gradual passive range of motion exercises. Active range of motion and strengthening exercises were introduced progressively as tolerated.

Follow up:   Not specified.

Orthopaedic implants used:   Tension band plate for acromion fixation Locking screws Cannulated screws Lag screws Mini-fragment plate Reconstruction plate