CP fractures are uncommon, accounting for around 1–3% of shoulder fractures. They are subdivided into fatigue fractures and traumatic fractures. The traumatic subtype is more common. Trap shooters, cricketers, and golfers are all prone to fatigue fractures. The three separate processes that induce traumatic fractures are impact, collision with an anteriorly dislocating humeral head, or indirect damage through the insertion of tendons or ligaments.
Road traffic accidents were the leading causative factor in traumatic fractures, followed by falls from height, sports, and falling off heavy objects on the shoulder.[3] The direct blow to the coracoid can result in a coracoid fracture, typically near the base. In adolescents, the fractures occur around the site of ossification.
Ogawa and colleagues classified them into two groups depending on the fracture's relationship to the coracoclavicular ligament. Type 1 fractures occur anterior to the coracoclavicular ligament, while type 2 is posterior.[4]. Our patient had a type 2 Ogawa type fracture. Type 1 is the predominant type, accounting for 77 percent of fractures. Type 2 injuries constitute 19%, while traction injuries 5%of all damages. [3]
Because of the anatomy, coracoid fractures could be easily overlooked. The possibility to miss a fracture is more frequent in Type 2 fractures than in type 1 fractures.[5] Initially, ignoring the fracture could lead to non–union, painful movement at the shoulder joint, instability, and difficulty in day-to-day activities. Surgical treatment is then warranted to achieve union. Therefore, special radiographs of the shoulder like scapula Y or lateral and axillary views should be performed to rule out a coracoid fracture. In specific cohorts like manual laborers and athletes, surgery is preferred.[6] Surgical fixation can be either open via anterior or posterior approach or fluoroscopy-guided. [7]Other modalities commonly utilized in diagnosing coracoid fracture are sonography and CT scan.[4] CT scan with three-dimensional reconstructions is the gold standard.
According to Ogawa, type 2 fractures can be managed conservatively. Conservative management is done by shoulder immobilization and elbow sling, followed by rigorous physiotherapy after the union. There are no clear indications for surgery for type 2 fractures. [6] [4]Although some advise surgical treatment.The indications for surgery include painful nonunion, > 1 cm displacement, concomitant scapula fracture on the same side with a 4mm step off in glenoid, 20mm medialization of glenohumeral joint, 25 degrees or more of angular deformity, and the presence of superior shoulder suspensory complex injuries.[6], [7] The coracoid fracture is most commonly associated with rib fractures, followed by the clavicle, pulmonary injuries, and brachial plexus injuries.[8]