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 TR was a 67-year-old woman who had a left-side os acromiale together with a rotator cuff tear, a type of partial articular supraspinatus tendon avulsion and a biceps hourglass impingement. The first operation (2009) was an arthroscopic decompression, biceps tenotomy and rotator cuff repair. Because of recurrent pain with documented impingement syndrome, an osteosynthesis with an osteosynthesis plate was performed. An osteotomy of 1 mm was performed either side of the non-union. Fixation was achieved using cortical and angle-stable screws (14 or 16 mm) and one compression screw was used. Her acromion was so small that the usual procedure of inserting 3.5-mm hollow screws was not possible. The bone remnants were pulverized and used as a bone graft.