Title
Extended Use of Arthrex® Dog Bone™ Button for Acromioclavicular Joint Stabilization in the Presence of Coracoid Fracture: A Case Report

Background

Acromioclavicular (AC) joint dislocations frequently occur with coracoid fractures, often referred to as a "double disruption" of the superior shoulder suspensory complex (SSSC). These injuries require careful surgical management to prevent decoupling of the shoulder girdle. The standard treatment for AC joint dislocation with associated coracoid fractures typically includes hook plate fixation, which can cause complications such as osteolysis and persistent pain, requiring additional surgery for removal. Arthroscopic techniques using suture button devices like the Dog Bone Button (Arthrex) offer a minimally invasive alternative, but they are not traditionally indicated for coracoid fractures.
Case
A 44-year-old female presented with left shoulder pain and deformity after a mountain biking accident. Imaging revealed a Rockwood Type V AC joint dislocation and a concomitant Ogawa type 1 coracoid fracture. Considering the complexity of the injury, a decision was made to proceed with arthroscopic-assisted AC joint stabilization using the Dog Bone Button, despite its non-indication for coracoid fractures. The minimal remaining stump of the coracoid was utilized to anchor the inferior part of the button. The coracoid fracture was managed conservatively due to the indirect reduction achieved by stabilizing the AC joint. The hook plate was avoided to prevent complications such as osteolysis, chronic pain, and the need for future surgical removal. At a follow-up of 2 years, the patient had an excellent radiological and functional outcome and return to mountain biking (after 9 months of surgery)

Conclusion

This case demonstrates the feasibility of using the Arthrex® Dog Bone™ Button for AC joint stabilization in complex injuries involving the coracoid. By avoiding the complications associated with hook plate fixation, this approach offers a minimally invasive alternative with successful outcomes. Indirect coracoid reduction through AC joint stabilization may provide adequate management in selected cases, expanding the potential indications for the suture button technique in treating SSSC injuries.