Outcomes of Conservatively Managed Coracoid Fractures in Wild Birds in the United Kingdom

Jonathan M Cracknell,Romain Pizzi,Eve Smaller,Alistair M Lawrie,Lisa Yon,Yolanda Martinez Pereira,Jane S Hopper

doi:10.1647/2016-195

Abstract

Coracoid fractures are a frequent presentation in wild birds, commonly caused by collisions with motor vehicles, windows, or other obstacles such as pylons. Despite this, there are few reports of outcomes, and those published consist of small numbers of birds with conflicting results when comparing conservative management with surgical intervention. To determine outcome success of conservative management in a larger population of wild birds, records of 232 adult wild birds in the United Kingdom (UK) with closed unilateral coracoid fractures confirmed on radiography and surviving more than 48 hours after admission were retrospectively analyzed. Conservative management had a high success rate, with 75% (n = 174/232; 95% confidence limits [CL]: 69%, 80%) of all birds successfully released back to the wild. The proportion of raptors successfully returned to the wild was even higher at 97% (n = 34/35; 95% CL: 85%, 99%). A significant difference of 26% (95% CL: 18%, 34%, Fisher exact test, P < .001) was demonstrated when comparing the outcome success of raptors (97%, n = 34/35) to nonraptors (71%, n = 140/198). The median time in captive care until released back to the wild was 30 days (95% CL: 27, 33). Conservative management of coracoid fractures in wild birds in the UK, and in particular in raptors, appears to result in good outcomes. The approach is low cost and noninvasive, in contrast to surgery, and is recommended as the first-line approach of choice in these cases.

Highlights

IntroductionThe coracoid acts as a supporting strut between the wing and sternum 1, 2
In flying birds, the coracoid acts as a supporting strut between the wing and sternum 1, 2
This study aimed to evaluate the outcomes of a larger number of conservatively managed coracoid fractures in wild birds than previously published studies, with the calculation of confidence intervals relevant for future evidence based clinical decision making, and to aid comparison with previous studies and any other future study outcomes with different sample sizes

Summary

Introduction

The coracoid acts as a supporting strut between the wing and sternum 1, 2. Coracoid fractures are a common presentation in wild birds. Despite the common presentation of this injury, the small number of previous studies on treatment outcomes have been limited by the low numbers of birds managed conservatively, and reports with conflicting findings [4, 6]. Scheelings 4 reported an 89% (n=16/18) success rate for birds' return to the wild for conservatively managed coracoid fractures, whereas Holz 6 reported only a 22% (n=2/9) success rate. The remainder of the publications on treatment outcomes from this injury are predominately single surgical case reports [7, 8], or expert opinion clinical experience reviews [9,10,11,12]; the Oxford Centre for Evidence Based Medicine ranks such papers as providing the lowest level of available evidence by which to make informed clinical decisions [13, 14]

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