Patient VL was a 28-year-old homeless male. He was admitted to the emergency room after a fall while cycling. He complained of pain in his right shoulder and an impaired range of motion. An X-ray showed a fracture of the acromion and the coracoid process with a slight dislocation of the fragments. This fracture was classified as an S2c fracture according to the lateral scapula suspension system (LSSS) introduced by Lambert et al. (). These fractures together with concomitant ligamentous lesions of the acromioclavicular (AC) ligament caused instability of his shoulder, which made an operation necessary.\nDuring surgery, compression of the fracture was achieved using one cortical and two angle-stable screws. Anterior fixation was achieved using six angle-stable screws (10 or 12 mm). The coracoid fracture was treated percutaneously with a hollow screw as described by Hillewaere and Dierickx (), with the exception that in our case radioscopic rather than arthroscopic monitoring of the reduction was used. After surgery, the patient was advised to stop smoking to avoid impairing the healing process.
Patient RF was a 42-year-old man who had a left side os acromiale with an impingement syndrome. He was first treated by a colleague orthopaedic surgeon, who performed three surgeries. The first was an arthroscopic limited decompression, followed by fixation with K-wires and tension band wiring. Because of an infection and perforation of the osteosynthesis materials, they were removed and replaced by two Acutrak screws. However, a monitoring CT showed loosening of these screws. The patient continued to suffer from a loss of strength and pain at night. As an alternative approach, an osteosynthesis using a distal clavicle osteosynthesis plate was performed. Fixation was achieved using cortical and angle-stable locking screws (4 × 10 mm and 2 × 12 mm). One compression screw was used. A bone graft was harvested from the left iliac crest and applied at the osteotomy site.