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Coracoid Process Fracture S42.133A 811.02

 

synonyms:coracoid process fracture, conjoined tendon origin fracture

Coracoid Process Fracture ICD-10

Coracoid Process Fracture ICD-9

  • 811.02 Fracture of scapula; closed, coracoid process
  • 811.12 Fracture of scapula; open, coracoid process

Coracoid Process Fracture Etiology / Epidemiology / Natural History

  • Uncommon.  3%-13% of all scapular fractures.  <1% of all fractures. 
  • Generally associated with acromial, clavicular, or scapular fracture, acromioclavicular separation or glenohumeral dislocation.

Coracoid Process Fracture Anatomy

  • Short head of the biceps,  coracobrachialis and pectoralis minor attached to the coracoid process.

Coracoid Process Fracture Clinical Evaluation

  • Tenderness and swelling in the anterior shoulder. 
  • Pain with abduction and external rotation. 
  • Document neurovascular examination.  May cause compression on the brachial plexus and suprascapular nerve.

Coracoid Process Fracture Xray / Diagnositc Tests

  • Shoulder xray demonstrates displacement of coracoid process.  May be difficult to see on plain films
  • MRI demonstrates osseous avulsion of the coracoid process and can be used to determine which muscles are attached to the displaced fragment. 
  • CT: best deliniates fracture configuration. 
  • Consider EMG prior to surgery. 

Coracoid Process Fracture Classification / Treatment

  • Nondisplaced: Conservative care with sling and activity limitations. 
  • Displaced: treatment is controversial.  Consider ORIF generally through an anterior approach with fixation with 3.5mm screw and washer.  

Coracoid Process Fracture Associated Injuries / Differential Diagnosis

Coracoid Process Fracture Complications

  • Infection
  • Refracture
  • Delayed union / nonunion
  • Hardware failure
  • Malunion
  • Incisional scar (cosmesis)
  • CRPS
  • Shoulder pain
  • Shoulder stiffness

Coracoid Process Fracture Follow-up Care

  • Post-op: sling for comfort, no overhead motion. Immediate pendelum ROM exercises.
  • 10-14 Days: Wound check, sutures removed. Start PT for gentle ROM exercises. No resistive exercises/activities. Sling as needed for comfort.
  • 6 weeks: Xrays, if union is evident begin strengthening and resistive exercises. No contant athletics.
  • 3 months: Repeat xrays. If pt is painfree and union is obvious pt may return to sport. Generally avoid contact sports and heaving lifting for 4-6 months.
  • Shoulder Outcome measures.

Coracoid Process Fracture Review References

  • Hill BW, Jacobson AR, Anavian J et-al. Surgical management of coracoid fractures: technical tricks and clinical experience. J Orthop Trauma. 2014;28 (5): e114-22.
  • Petty OH. “Fracture of the coracoid process of the scapula caused bymuscular action,” Annals of Surgery. 1907;45(3):427–430. Ogawa K, Yoshida A, Takahashi M, and Ui M, “Fractures of the coracoid process.”. Journal of Bone and Joint Surgery B, 1997; 79, (1):17-19.
  • McGinnis M, Denton JR. “Fractures of the Scapula: A Retrospective Study of 40 Fractured Scapulae. Journal of Trauma and Acute Care Surgery. 1989;29(11):1488–1493. 
  • Eyres KS, Brooks A, Stanley D. “Fractures of the Coracoid Process.” The Journal of Bone and Joint Surgery. 1995;77(3):425–428. 
  • Ada JR, Miller ME. “Scapular fractures: analysis of 113 cases.” Clinical Orthopaedics and Related Research. 1991;269:174–180. 
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