Abstract
Objectives and Design. Epiphyseal separation of the coracoid process (CP) rarely occurs in adolescents. In this retrospective case series, we reviewed the data of nine patients treated at our center and those of 28 patients reported in the literature. This injury can be classified into three types according to the injured area: Type I, base including the area above the glenoid; Type II, center including the coracoclavicular ligament (CCL); and Type III, tip with the short head of the biceps and coracobrachialis, as well as the pectoralis minor. Patients/Participants. A total of 37 patients were included in the analysis. Data on sex, age, cause and mechanism of injury, separation type, concomitant injury around the shoulder girdle, treatment, and functional outcomes were obtained. Main Outcome Measurements and Results. Type I is the most common type. The cause of injury and associated injury around the shoulder girdle were significantly different between Type I, II, and III fractures. The associated acromioclavicular (AC) dislocation and treatment were significantly different between Type I and III fractures. Our new classification system reflects the clinical features, imaging findings, and surgical management of epiphyseal separation of the CP. Type I and II fractures are mostly associated with AC dislocation and have an associated injury around the shoulder girdle. Type III fractures are typically caused by forceful resisted flexion of the arm and elbow. Although the latter are best managed surgically, whether conservative or surgical management is optimal for Type I and II fractures remains controversial. Conclusions. We noted some differences in the clinical characteristics depending on the location of injury; therefore, we aimed to examine these differences to develop a new system for classifying epiphyseal separation of the CP. This would increase the clinicians' awareness regarding this injury and lead to the development of an appropriate treatment.
Highlights
Data Extraction and Analysis. e medical records from our center and previously published studies were retrospectively reviewed to extract the data regarding sex, age, cause and mechanism of injury, separation type, concomitant injury around the shoulder girdle, treatment, and functional outcomes. In these 37 patients, separation occurred at the base of the coracoid process (CP). e separation occurred above the glenoid in 28 (76%) patients, at the center with coracoclavicular ligament (CCL) in 6 (16%), and at the tip of the short head of the biceps and coracobrachialis or the pectoralis minor in 3 (8%). e differences identified in the epiphyseal separation of the CP lesions were classified depending on the location of the injury (Figure 1): Type I, the base including the area above the glenoid (Figure 2); Type II, the center with CCL (Figure 3); and Type III, the tip including the short head of the biceps and coracobrachialis in addition to the pectoralis minor (Figure 4)
Ogawa et al proposed a new classification system dividing the CP into two distinct locations based on the CCL attachment: Type I fractures are located behind the ligaments, while Type II fractures are located in front of the ligaments [2]
Fractures classified as Type I according to our system are equivalent to Type I fractures of Ogawa et al and Type III, IV, and V fractures of the classification of Eyres et al Fractures classified as Type II by our system are equivalent to Type II fractures of the system of Ogawa et al and Type I and II fractures of Eyres et al our Type II classification is not equivalent to any type of previous systems
Summary
Fractures of the coracoid process (CP) do not commonly occur, accounting for only 2%–13% of all scapular fractures and approximately 1% of all fractures [1,2,3,4]. e epiphyseal separation of the CP in the adolescent is even more uncommon [5, 6], with few cases reported in the literature [1, 4, 7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]. is injury can complicate acromioclavicular (AC) dislocations and fractures of the coracoid in adults. E epiphyseal separation of the CP in the adolescent is even more uncommon [5, 6], with few cases reported in the literature [1, 4, 7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]. Is injury can complicate acromioclavicular (AC) dislocations and fractures of the coracoid in adults. A diagnosis of AC dislocation is made, the epiphyseal separation of the CP may be overlooked due to the complexity of the anatomical structures and superimposition on standard shoulder radiographs. Erefore, the appropriate classification of this injury is necessary. Several classification systems for coracoid fractures in adults have been proposed from previous studies, there is no available system for classifying epiphyseal separation of the CP in adolescents
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