Salter-Harris Type 1 coracoid process fracture in a rugby playing adolescent

Cross, George W V; Reilly, Peter; Khanna, Monica

doi:10.1259/bjrcr.20180011

Cited by 4 publications

(6 citation statements)

References 16 publications

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“…Its dislocation occurred in 9 patients; subluxation was sustained by 2 patients. 7 , 11 , 14 , 31 , 33 , 36 , 44 , 46 In these patients, the injured sites of the coracoid process were the base in 5 patients, intra-articular in 2, and apophysis at the angle in 4. A proximal humeral fracture was observed in 1 patient.…”

Section: Resultsmentioning

confidence: 93%

“…The primary coracoid ossification center combined with the subcoracoid ossification center was affected in 5 patients aged 9 to 15 years (mean, 12.8 years), forming an intra-articular fracture. 14 , 22 , 44 , 51 , 52 Apophyseal injuries of the tip occurred in 3 patients aged 15 and 16 years. 3 , 6 , 37 Apophyseal injuries of the angle occurred in 5 patients with associated acromioclavicular dislocation in 4 of these 5 patients, whose ages ranged from 14 to 17 years (mean, 15.4 years).…”

Section: Resultsmentioning

confidence: 99%

“…The primary coracoid ossification center, combined with the subcoracoid ossification center, was sometimes injured, forming an intra-articular fracture. 14,22,44,51,52 Although all the authors of these cases reported a physeal injury at the base, detailed examination of the provided images revealed that the subcoracoid ossification center was displaced with the primary coracoid ossification center. The age of these patients corresponds to the age immediately prior to the start of physeal closure of the subcoracoid ossification center.…”

Section: Discussionmentioning

confidence: 98%

“… § References 2 , 3 , 6 , 7 , 10 , 11 , 13 - 16 , 22 , 29 , 31 , 33 , 35 - 37 , 44 , 46 , 48 , 51 , 52 . …”

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Physeal Injuries of the Coracoid Process Are Closely Associated With Sports Activities: A Systematic Review

Ogawa

Inokuchi

Matsumura

2020

Orthopaedic Journal of Sports Medicine

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Background: Physeal injuries of the coracoid process are rare but may be increasing because of increased participation of youth in year-round sports. Purpose: To analyze reported physeal and apophyseal injuries of the coracoid process. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed and Scopus were searched using the terms scapula fracture and coracoid fracture. The inclusion criteria were English full-text articles describing coracoid fracture as well as articles that described patient characteristics and presented appropriate images. The exclusion criteria were descriptive cases without images as well as those lacking appropriate images. Citation tracking was conducted to find additional articles and full-text articles written in other languages. Articles were included if they reported physeal injury or judged to involve physeal injury based on the provided images. Results: Overall, 22 studies including 32 patients (29 males, 3 females) were identified. All but 2 patients were younger than 18 years of age, and 66% (21/32) had sustained injuries during or as a result of participation in sporting activities. The affected site was the physis at the base in 18 patients, an intra-articular fracture in the primary coracoid ossification center combined with the subcoracoid ossification center to form an intra-articular fracture in 5, the apophysis of the tip in 3, the apophysis of the angle in 5, and uncertain in 1. Eleven patients had concurrent acromioclavicular injuries. The injury was acute in 23 patients, chronic in 6, and traumatic nonunion in 3. Among 21 cases in which treatment methods and outcomes were described, 21% of the acute cases (4/19), and 2 of the 3 nonunions were surgically treated. Only 1 study used a widely accepted evaluation method. Follow-up periods ranged from 6 weeks to 2 years. Outcomes were generally excellent for nonoperative and operative treatment and without any serious complications. Conclusion: Coracoid physeal injuries occurred most commonly in patients aged 13 to 15 years of age (71%) and were usually sustained during or as a result of sports activities (66%). The most common injury site was the physis at its base. The cause of these injuries is probably severe or repeated traction of the attached muscles and ligaments. The majority of these injuries can be successfully treated nonoperatively.

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Section: Resultsmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

“… § References 2 , 3 , 6 , 7 , 10 , 11 , 13 - 16 , 22 , 29 , 31 , 33 , 35 - 37 , 44 , 46 , 48 , 51 , 52 . …”

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Physeal Injuries of the Coracoid Process Are Closely Associated With Sports Activities: A Systematic Review

Ogawa

Inokuchi

Matsumura

2020

Orthopaedic Journal of Sports Medicine

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“…Special radiograms are required in order to make a definitive diagnosis: 30° cephalad roentgenogram [ 7 ], 45° to 60° cephalad tilt [ 31 ], or abduction view that clearly scans the CP without overlapping other bone structures [ 9 , 16 ]. However, CT, especially three-dimensional CT, and magnetic resonance imaging are usually necessary because of the limitations of plain radiography [ 1 , 14 , 18 ]. Comparison of CT data from the healthy side may help in the accurate diagnosis of this condition.…”

Section: Discussionmentioning

confidence: 99%

New System for the Classification of Epiphyseal Separation of the Coracoid Process: Evaluation of Nine Cases and Review of the Literature

Mondori

Nakagawa

Kurata

et al. 2020

Advances in Orthopedics

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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.

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Presumed Glenoid SLAP Tear in an Adolescent Football Player Belied the Presence of a Coracoid Growth Plate Fracture: A Diagnostic Conundrum

Skedros

Marshall

Cronin

2022

Case Reports in Orthopedics

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We report the case of a 13-year-old male who sustained a right shoulder injury while playing quarterback in an American football game. A noncontrast MRI scan showed evidence of a possible grade 1 SLAP tear (SLAP = superior labral anterior-posterior), and surgery was recommended. However, at the preoperative visit, the surgeon was suspicious that the main source of pain had been missed. Bilateral shoulder radiographs taken for comparative analysis revealed a Salter-Harris type I coracoid growth-plate fracture. Therefore, the surgeon planned to manage the patient nonoperatively and postponed the proposed SLAP tear surgery. The patient was instructed to cease participation in athletic events and undergo physical therapy. Hoping to expedite his healing with platelet or stem cell injections, the parents sought an opinion from another physician who obtained a right shoulder MRI with intra-articular contrast. This confirmed that there was no SLAP tear. We concluded that the patient initially had glenohumeral and coracoclavicular ligament strains and a coracoid growth-plate fracture. The SLAP tear suggested by the initial MRI proved to be a red herring, belying an accurate diagnosis. The patient ultimately recovered fully with physical therapy and without surgery or other interventions.

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Salter-Harris Type 1 coracoid process fracture in a rugby playing adolescent

Cited by 4 publications

References 16 publications

Physeal Injuries of the Coracoid Process Are Closely Associated With Sports Activities: A Systematic Review

Physeal Injuries of the Coracoid Process Are Closely Associated With Sports Activities: A Systematic Review

New System for the Classification of Epiphyseal Separation of the Coracoid Process: Evaluation of Nine Cases and Review of the Literature

Presumed Glenoid SLAP Tear in an Adolescent Football Player Belied the Presence of a Coracoid Growth Plate Fracture: A Diagnostic Conundrum

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