肩甲骨烏口突起骨折 −肩甲帯部重複損傷からみた発生機序−
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Fractures of the coracoid process of the scapula apparently are rare. The purpose of this study was to investigate the pathogenesis, treatment and results of fractures of the coracoid process of the scapula associated with a complex injury of the shoulder girdle. The fractures were classified into 3 groups according to the fracture site; base type (57 cases, including 4 epiphyseal separations): base of the coracoid process was fractured, intermediated type (3 cases, including 1 epiphyseal separation): intermediate portion between base and tip of the coracoid process was fractured, tip type: (7 cases) tip of the coracoid process was fractured. The associated injuries were as follows; dislocation of the acromioclavicular joint: 45 cases, fractures of the acromion: 13 cases, fracture of the distal clavicle: 15 cases, fracture of the middle clavicle: 5 cases, dislocation of the shoulder: 3 cases. Only 3 cases which were a tip type, had no associated injuries. 18 cases were treated conservatively. 49 cases were treated surgically. Both the acromioclavicular joint mechanism (the acromiolcavicular joint, the acromion, the distal clavicle) and the coracoid process were operated on in 29 cases. Only the coracoid process was operated on in 6 cases. Only associated injury was operated on in 4 cases. Dewars method was performed in 10 cases. Most of all healed satisfactorily, but 6 cases treated conservatively had a nonunion of the coracoid process and complained of discomfort. The fractures of the coracoid process were often associated with complex injuries of the shoulder girdle. Especially, when the acromioclavicular joint mechanism were injured, we were careful of its diagnosis, because fractures of the coracoid process were often overlooked. In unstable fractures associated with complex injuries of the shoulder girdle, better results were achieved with surgical treatment.
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