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Published in: International Orthopaedics 4/2021

01-04-2021 | Scapular Fracture | Original Paper

Fractures of the coracoid process – pathoanatomy and classification: based on thirty nine cases with three dimensional computerised tomography reconstructions

Authors: Jan Bartoníček, Michal Tuček, Tomáš Strnad, Ondřej Naňka

Published in: International Orthopaedics | Issue 4/2021

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Abstract

Purpose

Until now, classifications of coracoid fractures have been based on plain radiographs, without use of 3D CT reconstructions. Therefore, the aim of the present study has been to describe the pathoanatomy of these fractures and their associated injuries to the shoulder girdle, on the basis of 3D CT reconstructions.

Methods

The cohort comprised 39 patients, who each sustained a coracoid fracture investigated with 3D CT reconstructions. The patients were assessed in terms of age, gender, pathoanatomy of the coracoid fracture, fractures of other parts of the scapula, and associated injuries to the shoulder girdle.

Results

We identified 24 fractures of the base, one fracture of the beak body, eight fractures of the apex, and six comminuted fractures of the coracoid process. A total of 22 associated injuries were found (7 fractures of the acromion, 5 fractures of the anterior glenoid rim, 3 fractures of the superior glenoid, 1 fracture of the inferior glenoid, 4 fractures of the surgical neck, 2 fractures of the scapular body) and 18 other associated injuries to the shoulder girdle (8 AC dislocations, 5 proximal humeral fractures, and 5 clavicular fractures).

Conclusion

On the basis of 3D CT reconstructions, four basic coracoid fracture patterns were identified. The authors´ findings and literature review have shown that a considerable number of coracoid fractures are combined with injuries to other parts of scapula and shoulder girdle. These associated injuries must be taken into account and targeted when taking the patient’s history, and during clinical and primarily radiological examinations.
Literature
2.
go back to reference Smith DM (1975) Coracoid fracture associated with acromioclavicular dislocation. Clin Orthop Relat Res 108:165–167CrossRef Smith DM (1975) Coracoid fracture associated with acromioclavicular dislocation. Clin Orthop Relat Res 108:165–167CrossRef
3.
go back to reference DiPaola M, Marchetto P (2009) Coracoid process fracture with acromioclavicular joint separation in an American football player: a case report and literature review. Am J Orthop 38:37–40PubMed DiPaola M, Marchetto P (2009) Coracoid process fracture with acromioclavicular joint separation in an American football player: a case report and literature review. Am J Orthop 38:37–40PubMed
5.
go back to reference Martin-Herrero T, Rodriguez-Merchan C, Munuera-Martinez L (1990) Fractures of the coracoid process: presentation of seven cases and review of the literature. J Trauma 30:1597–1599CrossRefPubMed Martin-Herrero T, Rodriguez-Merchan C, Munuera-Martinez L (1990) Fractures of the coracoid process: presentation of seven cases and review of the literature. J Trauma 30:1597–1599CrossRefPubMed
6.
go back to reference McArthur N, Singh B (2012) Good clinical outcome following non-operative treatment of concomitant fracture of the coracoid process and distal end of clavicle: a case report. J Orthop Case Rep 2:14–16PubMedPubMedCentral McArthur N, Singh B (2012) Good clinical outcome following non-operative treatment of concomitant fracture of the coracoid process and distal end of clavicle: a case report. J Orthop Case Rep 2:14–16PubMedPubMedCentral
8.
go back to reference Lim KE, Wang CR, Chin KC, Chen CJ, Tsai CC, Bullard MJ (1996) Concomitant fractures of the coracoid and acromion after direct shoulder trauma. J Orthop Trauma 10:437–439CrossRefPubMed Lim KE, Wang CR, Chin KC, Chen CJ, Tsai CC, Bullard MJ (1996) Concomitant fractures of the coracoid and acromion after direct shoulder trauma. J Orthop Trauma 10:437–439CrossRefPubMed
9.
go back to reference Lecoq C, Marck G, Curvale G, Groulier P (2001) Triple fracture du complexe suspenseur superieur de l’epaule: presentation d’un cas. Acta Orthop Belg 267:68–72 Lecoq C, Marck G, Curvale G, Groulier P (2001) Triple fracture du complexe suspenseur superieur de l’epaule: presentation d’un cas. Acta Orthop Belg 267:68–72
10.
go back to reference Mulawka B, Jacobson A, Schroder LK, Cole PA (2015) Triple and quadruple disruptions of the superior shoulder suspensory complex. J Orthop Trauma 29:264–270CrossRefPubMed Mulawka B, Jacobson A, Schroder LK, Cole PA (2015) Triple and quadruple disruptions of the superior shoulder suspensory complex. J Orthop Trauma 29:264–270CrossRefPubMed
11.
go back to reference Gonçalves MHL, Garcia JC Jr (2016) A comprehensive review of triple disruptions of the superior shoulder suspensory complex and case report. Acta Shoulder Elbow Surg 1:56–61 Gonçalves MHL, Garcia JC Jr (2016) A comprehensive review of triple disruptions of the superior shoulder suspensory complex and case report. Acta Shoulder Elbow Surg 1:56–61
12.
go back to reference Toft F, Moro F (2016) Quadruple disruption of the superior shoulder suspensory complex (SSSC) and outcome after one year of conservative treatment: a case report. J Clin Exp Orthop 2:13CrossRef Toft F, Moro F (2016) Quadruple disruption of the superior shoulder suspensory complex (SSSC) and outcome after one year of conservative treatment: a case report. J Clin Exp Orthop 2:13CrossRef
13.
go back to reference Westphal T, Lippisch R, Jürgens J, Piatek S (2018) Gleichzeitige Frakturen von Acromion und Korakoid [simultaneous fracture of the acromion and coracoid process: rare variant of double disruption of the superior shoulder suspensory complex]. Unfallchirurg 121:968–975CrossRefPubMed Westphal T, Lippisch R, Jürgens J, Piatek S (2018) Gleichzeitige Frakturen von Acromion und Korakoid [simultaneous fracture of the acromion and coracoid process: rare variant of double disruption of the superior shoulder suspensory complex]. Unfallchirurg 121:968–975CrossRefPubMed
14.
go back to reference Badam VK, Harsha TSS, Sankineani SR, Rachakonda KR, Bodanki C, Reddy AVG (2019) Triple disruption of the superiror shoulder suspensory complex - a case report. J Orthop Case Rep 9:39–42PubMedPubMedCentral Badam VK, Harsha TSS, Sankineani SR, Rachakonda KR, Bodanki C, Reddy AVG (2019) Triple disruption of the superiror shoulder suspensory complex - a case report. J Orthop Case Rep 9:39–42PubMedPubMedCentral
15.
go back to reference Cottias P, le Bellec Y, Jeanrot C, Imbert P, Huten D, Masmejean EH (2000) Fractured coracoid with anterior shoulder dislocation and greater tuberosity fracture - report of a bilateral case. Acta Orthop Scand 79:95–97CrossRef Cottias P, le Bellec Y, Jeanrot C, Imbert P, Huten D, Masmejean EH (2000) Fractured coracoid with anterior shoulder dislocation and greater tuberosity fracture - report of a bilateral case. Acta Orthop Scand 79:95–97CrossRef
16.
go back to reference Gupta PK, Acharya A, Mourya A (2016) Bilateral coracoid avulsion fracture with unilateral anterior instability with glenoid bone loss: use of avulsed fragment for reconstruction of glenoid. J Orthop Case Rep 6:81–84PubMedPubMedCentral Gupta PK, Acharya A, Mourya A (2016) Bilateral coracoid avulsion fracture with unilateral anterior instability with glenoid bone loss: use of avulsed fragment for reconstruction of glenoid. J Orthop Case Rep 6:81–84PubMedPubMedCentral
17.
go back to reference te Slaa RL, Verburg H, Marti RK (2001) Fracture of the coracoid process, the greater tuberosity, and the glenoid rim after acute first-time anterior shoulder dislocation: a case report. J Shoulder Elb Surg 10:489–492CrossRef te Slaa RL, Verburg H, Marti RK (2001) Fracture of the coracoid process, the greater tuberosity, and the glenoid rim after acute first-time anterior shoulder dislocation: a case report. J Shoulder Elb Surg 10:489–492CrossRef
18.
go back to reference Plachel F, Schandla JE, Ortmaier R, Auffarth A, Resch H, Bogner R (2017) The „triple dislocation fracture“: anterior shoulder dislocation with concomitant fracture of the glenoid rim, greater tuberosity and coracoid process - a series of six cases. J Shoulder Elb Surg 26: e278-e285 Plachel F, Schandla JE, Ortmaier R, Auffarth A, Resch H, Bogner R (2017) The „triple dislocation fracture“: anterior shoulder dislocation with concomitant fracture of the glenoid rim, greater tuberosity and coracoid process - a series of six cases. J Shoulder Elb Surg 26: e278-e285
20.
21.
go back to reference Ogawa K, Inokuchi S, Matsui K (1990) Fracture of the coracoid process. Acta Orthop Scand 61:7–8CrossRef Ogawa K, Inokuchi S, Matsui K (1990) Fracture of the coracoid process. Acta Orthop Scand 61:7–8CrossRef
22.
go back to reference Ogawa K, Yoshida A, Takahashi M, Ui M (1997) Fractures of the coracoid process. J Bone Joint Surg (Br) 78-B:17–19CrossRef Ogawa K, Yoshida A, Takahashi M, Ui M (1997) Fractures of the coracoid process. J Bone Joint Surg (Br) 78-B:17–19CrossRef
25.
go back to reference Eyres KS, Brooks A, Stanley D (1995) Fractures of the coracoid process. J Bone Joint Surg (Br) 77-B:425–428CrossRef Eyres KS, Brooks A, Stanley D (1995) Fractures of the coracoid process. J Bone Joint Surg (Br) 77-B:425–428CrossRef
26.
go back to reference Goss TP (1996) The scapula: coracoid, acromial and avulsion fractures. Am J Orthop 25:106–115PubMed Goss TP (1996) The scapula: coracoid, acromial and avulsion fractures. Am J Orthop 25:106–115PubMed
27.
go back to reference Bartoníček J, Tuček M, Klika D, Chochola A (2016) Pathoanatomy and computed tomography classification of glenoid fossa fractures based on 90 patients. Int Orthop 40:2383–2392CrossRefPubMed Bartoníček J, Tuček M, Klika D, Chochola A (2016) Pathoanatomy and computed tomography classification of glenoid fossa fractures based on 90 patients. Int Orthop 40:2383–2392CrossRefPubMed
28.
go back to reference Baudouin M (1909) Un cas de fracture du col chirurgical de l'omoplate d'origine préhistorique. Arch Provinc Chir 16:575–583 Baudouin M (1909) Un cas de fracture du col chirurgical de l'omoplate d'origine préhistorique. Arch Provinc Chir 16:575–583
29.
go back to reference South JF (1839) Case of fracture of the coracoid process of the scapula with partial dislocation of the humerus forwards and fracture of the acromion process of the clavicle. Med Chir Trans 22:100–109CrossRefPubMedPubMedCentral South JF (1839) Case of fracture of the coracoid process of the scapula with partial dislocation of the humerus forwards and fracture of the acromion process of the clavicle. Med Chir Trans 22:100–109CrossRefPubMedPubMedCentral
30.
31.
go back to reference Kelly C (1869) Fracture of the coracoid process of the scapula. Trans Pathol Soc London 20:270 Kelly C (1869) Fracture of the coracoid process of the scapula. Trans Pathol Soc London 20:270
32.
go back to reference Tanton J (1915) Fractures en général - Fractures des membres - membre supérieur. JB Bailliere, Paris Tanton J (1915) Fractures en général - Fractures des membres - membre supérieur. JB Bailliere, Paris
33.
go back to reference Bartoníček J, Tuček M, Naňka O (2018) Floating shoulder: myths and reality? J Bone Joint Surg Rew 6(10):e5 1–10 Bartoníček J, Tuček M, Naňka O (2018) Floating shoulder: myths and reality? J Bone Joint Surg Rew 6(10):e5 1–10
34.
go back to reference Bartoníček J, Tuček M, Frič V, Obruba P (2014) Fractures of the scapular neck: diagnosis, classifications and treatment. Int Orthop 38:2163–2173CrossRefPubMed Bartoníček J, Tuček M, Frič V, Obruba P (2014) Fractures of the scapular neck: diagnosis, classifications and treatment. Int Orthop 38:2163–2173CrossRefPubMed
Metadata
Title
Fractures of the coracoid process – pathoanatomy and classification: based on thirty nine cases with three dimensional computerised tomography reconstructions
Authors
Jan Bartoníček
Michal Tuček
Tomáš Strnad
Ondřej Naňka
Publication date
01-04-2021
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 4/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-020-04634-6

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