Summary
One-screw fixation in the Latarjet procedure is an alternative to double screw fixation. It allows a high rate of fusion at 3 months. This technique can be used safely particularly if the surgeon judges that there is a risk of graft fracture like in case of small coracoid graft.
Abstract
Open Latarjet using one-screw fixation achieves a high rate of graft fusion
Background
The open Latarjet procedure is a surgical option for patients with anterior shoulder instability and is particularly indicated for patients with glenoid bone loss. The efficacy of this surgery is specially related to the fusion of the coracoid graft in good position. With this aim in mind, it is usually recommended to use 2 screws to obtain a satisfactory bone union. However, the coracoid graft is sometimes small in some patients and the risk of graft fracture is real. In addition, the use of two screws reduces the cancellous surface area, which decreases the cancellous bone contact between the glenoid neck and the graft. The aim of this study was to evaluate the fusion rate of the coracoid graft after mini-open Latarjet using only one-screw graft fixation.
Methods
The study design was a retrospective series of 45 shoulders operated for an anterior traumatic shoulder instability with mini-open Latarjet procedure. The coracoid graft was fixed with one 4 mm diameter half-threaded cancellous screw with washer. All patients were operated by the same surgeon. As a postoperative protocol, anteroposterior, lateral X-rays and CT scan were performed 3 months after the surgery for evaluation of the fusion of the coracoid bone graft with the objective to authorize the return to sport activity. All 45 shoulders were assessed by X-rays and CT scan. The criteria for fusion was a complete bone bridge on CT Scan between the coracoid graft and the glenoid neck.
Results
The average age of the patients was 32 years (23 to 55). No complications were observed, particularly no coracoid graft fracture happened. The mean time between the surgery and the CT Scan evaluation was 2,7 months. Bone union was achieved in 44 patients (97%). Only one patient did not consolidate his graft at this time.
Conclusion
One-screw fixation in the Latarjet procedure is an alternative to double screw fixation. It allows a high rate of fusion at 3 months. This technique can be used safely particularly if the surgeon judges that there is a risk of graft fracture like in case of small coracoid graft.
Study level : 4.