A 14-year-old male patient with chronic shoulder pain
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The patient had a nonunion of a previous left coracoid fracture. The initial management at the time of his injury focused on the proximal humerus fracture; however, his persistent pain was attributed to this coracoid nonunion. Subtle widening of the left coracoid physis was evident on CT and it was not readily visible on plain radiographs. MRI of the left shoulder suggested signal increase at the base of the coracoid consistent with edema. A bone scan suggested decreased uptake at the left coracoid, which supports altered physeal activity. After discussion with the patient and his family, the decision was made for operative management of the coracoid nonunion.

The patient received a brachial plexus block and general anesthesia. He was placed in the beach chair position and an incision was made over the coracoid. The coracoid was approached through the deltopectoral interval and the cephalic vein was moved laterally. The coracoid was exposed and measured. Preoperative planning supported use of a 4-mm partially threaded screw that was about 45-mm long. The angle for insertion was measured in the preoperative CT and replicated in the OR using fluoroscopy (Figure 5). A guide wire was placed and its position and trajectory were confirmed using fluoroscopy. A cannulated drill was passed over the guide wire which was followed by placement of a cannulated partially threaded lag screw across the fracture. The drilling and compression across the physis were considered sufficient stimulation for fracture healing.