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Radiographic and clinical characterization of coracoid fractures: a retrospective cohort analysis

Abstract

Purpose

Coracoid fracture is a rare injury. The aim of this study is to present the demographics, clinical and radiologic characteristics, and outcomes of coracoid fracture in a cohort of 32 patients.

Methods

We queried our institutional electronic medical record database (years 2012–2020) to identify patients with coracoid fractures using specific International Classification of Disease-10 codes. Demographic data, injury details including mechanism of injury and associated injuries, imaging performed, and treatment outcomes were obtained from retrospective chart review. A radiologist reviewed all available imaging studies (radiographs/CT/MRI) and classified the fractures according to Ogawa and Eyres classifications. Missed diagnoses were determined by comparing initial imaging reports with the follow-up imaging obtained in the office.

Results

Thirty-two patients with coracoid fractures were identified during the study period. Sixteen fractures (50%) occurred in the setting of low-energy trauma. Twelve fractures were missed on initial radiographs, and diagnosis with three-view radiographs (AP, scapular-Y and axillary) was 88% compared to 33% (p < 0.03) with two views (AP, scapular-Y). The majority of fractures were non-displaced (94%), and 56% were Ogawa Type-II fractures. Associated injuries were seen in 81% of patients. Most fractures (94%) were treated without surgery with excellent outcomes.

Conclusion

Coracoid fractures continue to be a rare injury. In contrast to previous studies, in this case series of 32 patients, half of the fractures were associated with low-energy trauma, which correlated with higher percentage of non-displaced fractures and Ogawa Type-II fractures. Addition of the axillary view in the trauma radiographic series significantly improved the initial fracture detection rate.

Level IV

Retrospective study.

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Data availability

The authors of this paper affirm that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that there were no discrepancies from the study as planned. All data generated or analyzed during this study are included in this article.

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Funding

No funding was received for conducting this study.

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Affiliations

Authors

Contributions

All authors have approved the final manuscript. B-AE was major contributor to the conception and design of the study, acquisition and analysis of data, and drafting and revising the article. PY and GD provided substantial contributions to the conception and design of the study, acquisition and analysis of data, and drafting the article. ZJ provided substantial contributions to the conception and design of the study as well as critically revising the manuscript for intellectual content. PC provided substantial contributions to acquisition and assessment of imaging studies as well as critically revising the manuscript for intellectual content. VMS provided substantial contributions to the conception and design of the study, acquisition and analysis of data, and drafting and critically revising the manuscript for intellectual content.

Corresponding author

Correspondence to Erel Ben-Ari.

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Conflict of interest

Dr. Joseph D. Zuckerman is a design surgeon for Exactech Inc. and receives publishing royalties from Wolters Kluwer Health, Thieme Inc., and SLACK Inc. Dr. Zuckerman is a board member of the Musculoskeletal Transplant Foundation and has stocks in Hip Innovation Technology and Apos Therapy Inc. Dr. Virk is a consultant for Exactech Inc. All other authors have no relevant financial or non-financial interests to disclose.

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All authors gave their consent for publication of this study.

Ethical approval

This submission was reviewed and approved by the NYU. School of Medicine's Institutional Review Board (IRB) - study number: i19-01670.

Informed consent

According to the IRB approval for this study - a waiver of Informed Consent has been granted in accordance with 45 CFR 46.116 (d).

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Ben-Ari, E., Pines, Y., Gordon, D. et al. Radiographic and clinical characterization of coracoid fractures: a retrospective cohort analysis. Eur J Orthop Surg Traumatol (2021). https://doi.org/10.1007/s00590-021-03144-4

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Keywords

  • Coracoid fractures
  • Ogawa classification
  • Eyres classification
  • Acromioclavicular joint
  • Avulsion fractures