Anterior glenohumeral dislocations represent the most common of all dislocations. The primary trauma may lead to chronic shoulder instability. Bone defects of the glenoid rim are a frequent result of recurrent dislocations in the shoulder joint [
4‐
6]. A reconstruction of the osseous lesions is recommended in patients with relevant bone loss [
7‐
9]. Another impact of continuing shoulder dislocations might be a fracture of the coracoid process, which usually occurs in the company of acromioclavicular joint dislocations. However, Eyres
et al. as well as Kalicke
et al. have described a fracture of the coracoid process as a rare complication in patients with anterior shoulder dislocation [
10,
11]. In our case, the recurrent anterior glenohumeral dislocations led to a chronic instability and to an avulsion fracture of the coracoid process with the attached conjoined tendons. An isolated demolition of the coracoid process is unique and mostly treated conservatively [
10,
12,
13]. A dislocation of an osseous piece attached to the conjoined tendons as concomitant injury after recurrent anterior shoulder dislocations has not been previously described in the literature to the best of our knowledge. Different studies have shown that recurrent shoulder dislocations can lead to various accompanying lesions that develop over time and are not present after primary shoulder dislocation [
14]. Upon our patient’s first visit we suspected an acromioclavicular joint sprain without further bony or ligamentous lesions. Almost seven years and numerous luxations with spontaneous repositions later, he presented to our department again, this time with the abovementioned concomitant injuries such as a glenoid rim defect, a Hill-Sachs lesion and an avulsion fracture of the coracoid process. The exact date and mechanism of the avulsion fracture is not determinable.
The Latarjet procedure has been described as feasible option for treating shoulder instabilities even after failed operative repair [
15]. In addition to the osseous enlargement of the glenoid rim, the sling effect of the conjoined tendons is considered an essential part for regaining stability of the shoulder joint [
2,
3]. Therefore we decided to perform an open Latarjet procedure in our surgical intervention. Intraoperatively, we identified the osseous piece with attachment of the conjoined tendons as quite big, so a sole re-fixation of the bone fragment probably would have induced enough stability in the shoulder joint. It can be debated which operative technique would have been most suitable: a sole re-fixation of the avulsed osseous piece with the adjacent conjoint tendons, a glenoid reconstruction with an iliac crest bone graft or the utilization of an open coracoid process transfer.Retrospectively an avulsed piece of bone can be detected in the preoperative CT and probably even in the preoperative X-rays, taken six years after the initial trauma (Figures
6 and
1). However, it still remains difficult to assign the osseous fragment to the coracoid process. Since the literature did not describe the combination of anterior shoulder instability, a bony glenoid defect and an avulsion fracture of the coracoid process with the adjacent conjoined tendons we did not consider this rare combination; he presented without a loss of strength or impairment of shoulder movement upon his visits in our department.