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.
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.