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 VR was a 60-year-old homeless male. He experienced a frontal collision on his motorcycle under the influence of alcohol. He had a history of alcohol, nicotine and heroin abuse. He complained about pain in his right shoulder. A CT showed fractures of the acromion, the coracoid process with an intra-articular glenoid component, the scapula tip and three rib fractures. These fractures could be classified according to the LSSS as S1b and S2c fractures, without including the concomitant scapular tip fracture and three rib fractures (Lambert et al., ). This scapular fracture was similar to that of patient VL, and there was also a rupture of the AC ligaments, which caused instability.\nThis fracture was set using an osteosynthesis plate and six anterior 12-mm angle-stable locking screws and three posterior compression screws. The AC ligaments were repaired and the coracoid fracture was treated the same way as that of patient VL. A monitoring X-ray showed good positioning of the osteosynthesis plate and screws.