Orthogonal biplanar fluoroscopy-guided percutaneous fixation of a coracoid base fracture associated with acromioclavicular joint dislocation.

Coracoid process fractures that involve the coracoid base (inferior pillar) without a concomitant rupture of the coracoclavicular ligaments can destabilize the acromioclavicular joint with its subsequent dislocation; prophylactic or therapeutic operative treatment involving open reduction and internal fixation has been traditionally recommended. This report presents a new technique of percutaneous reduction and stabilization of the coracoid fracture with indirect acromioclavicular joint reduction under fluoroscopic guidance; biplanar visualization of coracoid process anatomy is obtained using 2 specific radiographic/fluoroscopic-beam angulations (Bhatia views), and this permits a guided placement of screws for controlled reduction of this dual injury. The technique is based on the author's original work on coracoid process anatomy and development of radiographic views for orthogonal visualization of coracoid pillars in their entirety. Technical tips to facilitate percutaneous fracture fixation and to avoid potential complications are discussed.