An Isolated Displaced Fracture of the Coracoid Process Treated with Osteosynthesis—A Case Report and Review of Literature

Adala Raviraj, Ashish Anand, Srinivas Vijay

Department of Orthopaedic Surgery, Fortis Hospitals Ltd., Bangalore, India.

DOI: 10.4236/ss.2013.42034                

Abstract

Coracoid process fractures are relatively rare and few cases have been reported in the orthopedic literature. In this article, we report the case of an active, thirty years old, male patient with isolated, displaced fracture of the coracoid process, associated with a blunt injury to the shoulder, during a motor vehicle accident. We describe the incidence, mechanism of injury, and surgical treatment. Although rare, a high index of suspicion, special radiographic views, can detect an isolated coracoid process. Knowledge of the associated injuries will help the clinician to order further imaging and treat them accordingly. We recommend that a displaced, isolated fracture of the coracoid be treated with open reduction and osteosynthesis, to achieve early use of the extremity, good radiological union and clinical function.

Keywords

Fracture Coracoid; Isolated Fracture; Associated Injuries; Osteosynthesis; Open Reduction; Internal Fixation

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	O. H. Petty, “Fracture of the Coracoid Process of the Scapula Caused by Muscular Action,” Annals of Surgery, Vol. 45, No. 3, 1907, pp. 427-430. doi:10.1097/00000658-190703000-00008
[2]	F. Caesar, “Isolierter Bruch des Rabenschnabelfortsatzes und Seine Rontgendarstellung,” Fortschritte auf dem Gebiete der Rontgenstrahlen, Vol. 35, No. 5, 1926, pp. 519-520.
[3]	K. Horn, “Beobachtung Eines Uberlastungsschadens der Schulterblattgrate und des Proccoracoideus,” Wschr Unfallheilk, Vol. 49, No. 1, 1942, pp. 53-59.
[4]	M. McGinnis and J. R. Denton, “Fractures of the Scapula: A Retrospective Study of 40 Fractured Scapulae,” Journal of Trauma and Acute Care Surgery, Vol. 29, No. 11, 1989, pp. 1488-1493. doi:10.1097/00005373-198911000-00006
[5]	K. Ogawa, S. Inokuchi and K. Matsui, “Fracture of the Coracoid Process,” Acta Orthopaedica Scandinavica, Vol. 61, No. 1, 1990, pp. 7-8.
[6]	K. S. Eyres, A. Brooks and D. Stanley, “Fractures of the Coracoid Process,” The Journal of Bone and Joint Surgery, Vol. 77, No. 3, 1995, pp. 425-428.
[7]	F′ery A, Sommelet J. Fracture of the coracoid process. Rev Chir Orthop Reparatrice Appar Mot 1979; 65:403-7.
[8]	P. P. Mariani, “Isolated Fracture of the Coracoid Process in an Athlete,” The American Journal of Sports Medicine, Vol. 8, No. 2, 1980, pp. 129-130. doi:10.1177/036354658000800214
[9]	J. F. Gil and A. Haydar, “Isolated Injury of the Coracoid Process: Case Report,” Journal of Trauma, Vol. 31, No. 12, 1991, pp. 1696-1697. doi:10.1097/00005373-199112000-00023
[10]	T. N. Bernard Jr., M. E. Brunet and R. J. Haddad Jr., “Fractured Coracoid Process in Acromioclavicular Dislocations. Report of Four Cases and Review of the Literature,” Clinical Orthopaedics and Related Research, Vol. 175, No. 5, 1983, pp. 227-232.
[11]	D. Herscovici Jr., A. G. Fiennes, M. Allg?wer and T. P. Rüedi, “Coracoid Fractures,” Journal of Bone and Joint Surgery, Vol. 74, No. 3, 1992, pp. 362-364.
[12]	J. P. Zettas and P. D. Muchnic, “Fracture of the Coracoids Process Base and Acute Acromioclavicular Separation,” Orthopedic Reviews, Vol. 5, No. 1, 1976, pp. 77-79.
[13]	R. C. Rounds, “Isolated Fracture of the Coracoid Process,” Journal of Bone and Joint Surgery, Vol. 31, No. 3, 1949, p. 662.
[14]	M. Garcia-Elias and J. M. Salo, “Non-Union of a Fractured Coracoid Process after Dislocation of the Shoulder. A Case Report,” Journal of Bone and Joint Surgery, Vol. 67, No. 5, 1985, pp. 722-723.
[15]	M. S. Moneim and F. C. Balduini, “Coracoid Fracture as a Complication of Surgical Treatment by Coracoclavicular Tape Fixation. A Case Report,” Clinical Orthopaedics and Related Research, Vol. 168, 1982, pp. 133-135.
[16]	D. W. Boyer Jr., “Trapshooter’s Shoulder: Stress Fracture of the Coracoid Process. Case Report,” Journal of Bone and Joint Surgery, Vol. 57, No. 6, 1975, p. 862.
[17]	C. A. Rockwood, “Management of Fractures of the Scapula,” Orthopaedics Transactions, Vol. 10, 1986, p. 219.
[18]	R. P. Goldberg and B. Vicks, “Oblique Angled View for Coracoid Fractures,” Skeletal Radiology, Vol. 9, No. 3, 1983, pp. 195-197. doi:10.1007/BF00352554
[19]	R. Ideberg, “Fractures of the Scapula Involving the Glenoid Fossa,” In: J. E. Bateman and R. P. Welsh, Eds., Surgery of the Shoulder, Decker, Philadelphia, 1984, pp. 63-66.
[20]	Z. Zilberman and R. Rejovitzky, “Fracture of the Coracoid Process of the Scapula,” Injury, Vol. 13, No. 3, 1981, pp. 203-206. doi:10.1016/0020-1383(81)90239-4
[21]	T. Martin-Herrero, C. Rodriguez-Merchan and L. Munuera-Martinez, “Fractures of the Coracoid Process: Presentation of Seven Cases and Review of the Literature,” The Journal of Trauma and Acute Care Surgery, Vol. 30, No. 12, 1990, pp. 1597-1599. doi:10.1097/00005373-199012000-00031
[22]	A. J. Carr and N. S. Broughton, “Acromioclavicular Dislocation Associated with Fracture of the Coracoid Process,” The Journal of Trauma and Acute Care Surgery, Vol. 29, No. 1, 1989, pp. 125-126. doi:10.1097/00005373-198901000-00030
[23]	A. S. Subramanian, M. A. Khalik and M. M. Shah, “Isolated Fracture of the Coracoid Process Associated with Unstable Shoulder,” ANZ Journal of Surgery, Vol. 77, No. 3, 2007, pp. 188-189. doi:10.1111/j.1445-2197.2006.04005.x
[24]	C. Spormann, P. Holzach and C. Ryf, “[Isolated Coracoid Fracture—Open Reposition and Osteosynthesis—Report of 3 Cases],” Swiss Surgery, No. 4, 1998, pp. 198-202.
[25]	J. Guiral, J. L. Real and J. M. Curto, “Isolated Fracture of the Coracoid Process of the Scapula,” Acta Orthopaedica Belgica, Vol. 62, No. 1, 1996, pp. 60-61.
[26]	M. C. Wilbur and E. B. Evans, “Fractures of the Scapula: An Analysis of Forty Cases and Review of Literature,” The Journal of Bone and Joint Surgery, Vol. 59, No. 3, 1977, pp. 358-362.
[27]	S. D. Martin and A. J. Weiland, “Missed Scapular Fracture after Trauma,” Clinical Orthopaedics, Vol. 299, 1994, pp. 259-262.
[28]	D. M. Smith, “Coracoid Fracture Associated with Sternoclavicular Dislocation: A Case Report,” Clinical Orthopaedics, Vol. 108, 1975, pp. 165-167. doi:10.1097/00003086-197505000-00026
[29]	K. S. Eyres, A. Brooks and D. Stanley, “Fractures of the Coracoid Process,” The Journal of Bone and Joint Surgery, Vol. 77, 1995, pp. 425-428.
[30]	K. Ogawa, A. Yoshida, M. Takahashi and M. Ui, “Fractures of the Coracoid Process,” The Journal of Bone and Joint Surgery, Vol. 79, No. 1, 1997, pp. 17-19. doi:10.1302/0301-620X.79B1.6912
[31]	A. Steindler, “Traumatic Deformities and Disabilities of the Upper Extremity,” Thomas, Springfield, 1946, pp. 112-118.
[32]	J. Benson and C. Nelson, “Avulsion of Coracoid Process in an Athlete,” The Journal of Bone and Joint Surgery, Vol. 53, 1971, pp. 356-358.