Defining impairment and treatment of subacute and chronic fractures of the coracoid process.

BACKGROUND: Concerning subacute and chronic coracoid fractures, the details of these disorders and its consequent treatment methods have not yet been established.
METHODS: Fifteen patients who received treatment at 23 weeks +/- 23 weeks after injury were followed up for 23 months +/- 10 months. There were 10 type I fractures and 5 type II fractures according to the classification proposed by Ogawa et al. Associated shoulder girdle injuries were more frequent in the type I fractures.
RESULTS: Concerning the treatment for type I fractures, all of the four patients first seen within 5 weeks after injury and adequately treated during this period were conservatively treated. The other six patients visiting later than 5 weeks required surgery because of severe motion-produced pain. Of type II fractures, four were asymptomatic at the first visit and the remaining one with atypical subcoracoid impingement symptoms needed surgery. In the type I fracture group, except one patient, all four conservatively treated and five surgically treated patients exhibited no symptoms at follow-up. All five patients with type II fractures developed nonunion, of whom four patients remained free from pain.
CONCLUSION: In the overlooked and untreated type I fracture with persistent pain and functional impairment, reduction and fixation of the coracoid fracture aimed at reconstruction of the firm scapuloclavicular connection and structural restoration of the coracoacromial arch results in gratifying outcomes. In the cases of type II fracture, conservative treatment is indicated. When presenting with atypical manifestations of subcoracoid impingement, releasing of the coracoacromial ligament proves effective.