Complications of coracoid fractures include hemorrhage into the muscles of the rotator cuff and damage to the suprascapular nerve.
Coracoid fractures have been classified into 5 types based on the location of the fracture plane:
- Type 1: Involve the tip (epiphyseal fracture)
- Type 2: Through the midportion.
- Type 3: Through the base (basal fracture). Most common.
- Type 4: Extend to the superior body of the scapula.
- Type 5: Extend into the glenoid fossa.
Management is usually conservative for types 1-3. Internal fixation is often recommended for types 4 and 5.
A simpler classification divides them into two types based on the relationship of the fracture to the coracoclavicular ligaments: Type-I fractures are proximal to this attachment and can disrupt the scapuloclavicular connection. Type-II fractures are distal to the coracoclavicular ligaments. Type I fractures often require internal fixation, while type II fractures can be managed conservatively.
The image above shows a type 2 fracture. The anteroposterior view reveals a double contour of the coracoid process (pink arrow), suggestive of displacement and early callus formation. The axillary view shows the fracture plane (white arrows) through the midportion of the coracoid process.