Coracoid Process Fracture in a High School Football Player

We presented a unique case of a high school athlete who suffered from a coracoid process fracture following a collision with an opposing player. This fracture is commonly misdiagnosed as a clavicular fracture or AC joint sprain. Initial radiographic examination may fail to identify the fracture site. Understanding the clinical features of this injury is an important prerequisite to its overall management. Any misdiagnosis or alteration from the appropriate course of treatment can inhibit return to play and may be avoided by using indicated diagnostic evaluation tools. Scapular fractures occur infrequently, as they only account for 1% of all fractures and fewer than 5% of shoulder girdle injuries (Cottalorda, Allard, Dutour, & Chavrier, 1996). In addition, coracoid process fractures occur significantly less, accounting for only 3 to 13% of all scapular fractures with the most common mechanism of injury for coracoid process fractures being a direct blow or a forceful muscular contraction causing an avulsion fracture (Cottalorda et al., 1996; Protass, Stampfli, & Osmer, 1974). Coracoid process fractures are frequently missed due to inadequate radiographic screening and the occult nature of this injury. It is therefore important that clinicians be knowledgeable concerning the clinical manifestations of a coracoid process fracture. Recognition, advanced medical referral and appropriate follow-up of this enigmatic injury may augment the efficacy of treatment and result in an expeditious return to sport and functionality. The unique case presented in this report emphasizes the importance of appropriate overall health care for coracoid process fractures, and provides advanced clinical insight and education for certified athletic trainers, athletic therapists, physical therapists and other sports medicine professionals. The scapula is a flat, triangular-shaped bone on the posterior aspect of the thorax. Bony landmarks include the spine, the acromion process and the coracoid process (Arnheim & Prentice, 2000). The coracoid process projects anteriorly from the supero-lateral apex of the scapula (Arnheim & Prentice, 2000). Muscular attachment of the biceps brachii, coracobrachialis, and pectoralis minor occur at the coracoid process. In addition, ligamentous support is created through the attachment of the coracoacromial, coracohumeral and coracoclavicular ligaments (Arnheim & Prentice, 2000; Mahaffey & Smith 1999). The scapula is attached to the clavicle by the acromioclavicular and coracoclavicular ligaments and articulates with the humerus at the glenoid fossa (Arnheim & Prentice, 2000). The primary function of the scapula is to attach the upper extremity to the thorax and provide a stabilized platform for upper extremity movement (Arnheim & Prentice, 2000; Mahaffey & Smith, 1999). Forced shoulder adduction or elbow flexion exacerbates the pain of a scapular fracture (Cottalorda et al., 1996). Plain radiographs that show anterior posterior views of the scapular may fail to reveal the complete structure and may need to be supplemented with oblique angle views (Goldberg & Vicks, 1985). The scapula is ossified at several locations (Cottalorda et al., 1996). From the fifteenth to the eighteenth month after birth, ossification takes place in the middle of the coracoid process, joining with the rest of the bone during adolescence around the fifteenth year (Cottalorda et al., 1996). Between age fourteen and twenty, ossification continues at the root of the coracoid