Transfer of the coracoid and conjoined tendon for failed, unstable, short clavicle following excessive outer clavicle resection

Nineteen patients presented with an unsightly deformity of the shoulder, pain or discomfort at the medial scapular border, pseudo nonparalytic scapular winging, and thoracic outlet symptoms after excessive resection of the clavicle for either complete acromioclavicular separation or displaced fracture of the outer clavicle, which allows the scapula and shoulder to rotate anteriorly and inferiorly on the chest creating traction on the medial scapular muscles and the brachial plexus resulting in pseudo nonparalytic winging and thoracic outlet symptoms. All underwent transfer of the coracoid process with the attached conjoined tendon to the end of the clavicle, restoring length and alignment. Eighteen patients were evaluated at a mean of 13.3 years. Seventeen had resolution of symptoms, restored alignment of the clavicle with the shoulder, improved appearance, healed transfer, and were pleased with the outcome. One patient was lost to follow-up but was considered a failure at his last visit. In a second patient, the transfer healed in a tilted position and the patient was dissatisfied with the appearance but otherwise had resolution of his symptoms. The mean American Shoulder and Elbow Surgeons Outcome Score improved from 53.2 preoperatively to 87.4 postoperatively (P < .02). This is the first report of using this transfer to restore length and alignment of an excessively short, unstable clavicle. The transfer succeeded in improving the appearance and symptoms in this complication of an excessively short, unstable clavicle.