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 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.