Skip to main content

Advertisement

Log in

Treatment of coracoid process fractures: a systematic review

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The coracoid process is a small hook-shaped feature on the scapula and a key structure of the superior shoulder suspensory complex (SSSC). Fractures of the coracoid are rare. Therefore, no consensus exists regarding treatment of coracoid process fractures. Systematically review indications, outcomes and complications of traumatic coracoid process fractures in adults, and to provide a treatment algorithm.

Materials and methods

A systematic review was performed to identify all relevant studies on the treatment of coracoid process fractures. The methodological quality of the studies was scored using the Methodological Index for Non-Randomized Studies (MINORS).

Results

Eight case series, with a total of 110 coracoid process fractures, were included. All studies were of moderate methodological quality. Of the fractures, 78% were Ogawa type I fractures, 13% Ogawa type II and 9% were unclassified. Conservative treatment showed good results in most Ogawa type II fractures and type I fractures without associated disruptions of the SSSC. Most Ogawa type I fractures with associated disruptions of the SSSC received surgical treatment showing good results.

Conclusion

Based on moderate quality studies, surgical treatment may be considered in Ogawa type I fractures with multiple disruptions of the SSSC. A conservative treatment seems sufficient in other fracture types.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Gil JF, Haydar A (1991) Isolated injury of the coracoid process: case report. J Trauma 31:1696–1697

    Article  CAS  Google Scholar 

  2. Goss TP (1993) Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma 7:99–106

    Article  CAS  Google Scholar 

  3. Butters KP (1990) The scapula. In: Rockwood CA Jr, Matsen FA II (eds) The shoulder, vol 1. WB Saunders, Philadelphia

    Google Scholar 

  4. Mulawka B, Jacobson A, Schroder L, Cole P (2015) Triple and quadruple disruptions of the superior shoulder suspensory complex. J Orthop Trauma 29:264–270. https://doi.org/10.1097/BOT.0000000000000275

    Article  PubMed  Google Scholar 

  5. Leung KS, Lam TP (1993) Open reduction and internal fixation of ipsilateral fractures of the scapular neck and clavicle. J Bone Joint Surg Am 75:1015–1018

    Article  CAS  Google Scholar 

  6. Rikli D, Regazzoni P, Renner N (1995) The unstable shoulder girdle: early functional treatment utilizing open reduction and internal fixation. J Orthop Trauma 9:93–97

    Article  CAS  Google Scholar 

  7. Williams GRJ, Naranja J, Klimkiewicz J et al (2001) The floating shoulder: a biomechanical basis for classification and management. J Bone Joint Surg Am 83A:1182–1187

    Article  Google Scholar 

  8. van Noort A, van der Werken C (2006) The floating shoulder. Injury 37:218–227. https://doi.org/10.1016/j.injury.2005.03.001

    Article  PubMed  Google Scholar 

  9. Ogawa K, Yoshida A, Takahashi M, Ui M (1997) Fractures of the coracoid process. J Bone Joint Surg Br 79:17–19

    Article  CAS  Google Scholar 

  10. Froimson AI (1978) Fracture of the coracoid process of the scapula. J Bone Joint Surg Am 60:710–711

    Article  CAS  Google Scholar 

  11. Benchetrit E, Friedman B (1979) Fracture of the coracoid process associated with subglenoid dislocation of the shoulder. A case report. J Bone Joint Surg Am 61:295–296

    Article  CAS  Google Scholar 

  12. Rabbani GR, Cooper SM, Escobedo EM (2012) An isolated coracoid fracture. Curr Probl Diagn Radiol 41:120–121. https://doi.org/10.1067/j.cpradiol.2011.07.025

    Article  PubMed  Google Scholar 

  13. Eyres KS, Brooks A, Stanley D (1995) Fractures of the coracoid process. J Bone Joint Surg Br 77:425–428

    Article  CAS  Google Scholar 

  14. Boyer DWJ (1975) Trapshooter’s shoulder: stress fracture of the coracoid process. Case report. J Bone Joint Surg Am 57:862

    Article  Google Scholar 

  15. Saddy S, Bergen CJA, Alta TDW et al (2016) Een fractuur van het ravenbekuitsteeksel: conservatief of operatief? Ned Tijdschr Voor Traumachir 24:27–33. https://doi.org/10.1007/s12506-016-0037-1

    Article  Google Scholar 

  16. Mohammed H, Skalski MR, Patel DB et al (2016) Coracoid process: the lighthouse of the shoulder. Radiographics 36:2084–2101. https://doi.org/10.1148/rg.2016160039

    Article  PubMed  Google Scholar 

  17. Vaienti E, Pogliacomi F (2012) Delayed diagnosis of isolated coracoid process fractures: results of 9 cases treated conservatively. Acta Bio-Medica Atenei Parm 83:138–146

    Google Scholar 

  18. Carr AJ, Broughton NS (1989) Acromioclavicular dislocation associated with fracture of the coracoid process. J Trauma 29:125–126

    Article  CAS  Google Scholar 

  19. 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 30:1597–1599

    Article  CAS  Google Scholar 

  20. Kim K-C, Rhee K-J, Shin H-D et al (2009) Displaced fracture of the coracoid process associated with acromioclavicular dislocation: a two-bird-one-stone solution. J Trauma 67:403–405. https://doi.org/10.1097/TA.0b013e3181ac8ef1

    Article  PubMed  Google Scholar 

  21. Ogawa K, Matsumura N, Ikegami H (2012) Coracoid fractures: therapeutic strategy and surgical outcomes. J Trauma Acute Care Surg 72:E20–26

    Article  Google Scholar 

  22. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  23. Slim K, Nini E, Forestier D et al (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716

    Article  Google Scholar 

  24. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop 214:160–164

    Google Scholar 

  25. Constant CR, Gerber C, Emery RJH et al (2008) A review of the Constant score: modifications and guidelines for its use. J Shoulder Elbow Surg 17:355–361. https://doi.org/10.1016/j.jse.2007.06.022

    Article  PubMed  Google Scholar 

  26. Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608. https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602:AID-AJIM4>3.0.CO;2-L

    Article  CAS  PubMed  Google Scholar 

  27. Davis AM, Beaton DE, Hudak P et al (1999) Measuring disability of the upper extremity: a rationale supporting the use of a regional outcome measure. J Hand Ther 12:269–274

    Article  CAS  Google Scholar 

  28. Beaton DE, Katz JN, Fossel AH et al (2001) Measuring the whole or the parts? Validity, reliability, and responsiveness of the disabilities of the arm, shoulder and hand outcome measure in different regions of the upper extremity. J Hand Ther 14:128–146

    Article  CAS  Google Scholar 

  29. Angst F, Pap G, Mannion AF et al (2004) Comprehensive assessment of clinical outcome and quality of life after total shoulder arthroplasty: usefulness and validity of subjective outcome measures. Arthritis Rheum 51:819–828. https://doi.org/10.1002/art.20688

    Article  PubMed  Google Scholar 

  30. Getahun TY, MacDermid JC, Patterson SD (2000) Concurrent validity of patient rating scales in assessment of outcome after rotator cuff repair. J Musculoskelet Res 4:119–127

    Article  Google Scholar 

  31. Othman A, Taylor G (2004) Is the constant score reliable in assessing patients with frozen shoulder? 60 shoulders scored 3 years after manipulation under anaesthesia. Acta Orthop Scand 75:114–116. https://doi.org/10.1080/00016470410001708230

    Article  PubMed  Google Scholar 

  32. Hill BW, Jacobson AR, Anavian J, Cole PA (2014) Surgical management of coracoid fractures: technical tricks and clinical experience. J Orthop Trauma 28:e114–122. https://doi.org/10.1097/01.bot.0000435632.71393.bb

    Article  PubMed  Google Scholar 

  33. Ogawa K, Ikegami H, Takeda T, Watanabe A (2009) Defining impairment and treatment of subacute and chronic fractures of the coracoid process. J Trauma 67:1040–1045. https://doi.org/10.1097/TA.0b013e318184205c

    Article  PubMed  Google Scholar 

  34. Plachel F, Schanda JE, Ortmaier R et al (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 Elbow Surg 26:e278–e285. https://doi.org/10.1016/j.jse.2017.01.022

    Article  PubMed  Google Scholar 

Download references

Funding

There is no funding source.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Peter G. van Doesburg.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

van Doesburg, P.G., El Saddy, S., Alta, T.D. et al. Treatment of coracoid process fractures: a systematic review. Arch Orthop Trauma Surg 141, 1091–1100 (2021). https://doi.org/10.1007/s00402-020-03496-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-020-03496-2

Keywords

Navigation