Management of Patella Fractures Non-amenable to Tension Band Wiring: Series of Nine Cases with Review of Literature.

INTRODUCTION: Isolated coracoid process fracture of scapula is a rare. Usually, it happens along with the rotator cuff tear, dislocation of acromioclavicular joint, or glenohumeral joint. Displaced fracture will cause impairment of upper limb movement. Since there are very low numbers of cases reported so far, the treatment is still controversial.

CASE REPORT: We report a case of a 42-year-old male laborer with motor vehicle accident, following which he had pain and restricted movements on his left shoulder. On examination, Glasgow Coma Scale 15/15 and left shoulder had swelling and tenderness at mid-third clavicle. Range of motion (ROM) is painful and restricted. Plain radiograph shows suspected fracture at coracoid process and computerized tomography scan confirms displaced isolated coracoid process fracture. He underwent open reduction with internal fixation with a 4 mm cannulated cancellous screw with washer. Following surgery, initial 2 weeks shoulder immobilized in arm sling and gradual pendulum exercise was started as pain tolerable. At the end of 6 weeks, radiological investigation showed fracture united and he was advised to do ROM exercise and restricted activity of daily living. At the end of 3 months, he was able to do his normal activity of daily living as before injury. The patient followed up to 6 months and had full range of movements in all directions and there was no pain and he was able to do daily activities.

CONCLUSION: In this case of isolated coracoid fracture was found displaced more than 1 cm, hence we preferred open reduction and internal fixation with 4 mm cannulated cancellous screw with washer to avoid non-union.