An unusual mechanism of coracoid fracture in a beginner golfer

A Scoping Review of the Epidemiology, Management, and Outcomes of Golf-Related Fractures

ABSTRACT

Golf is a popular sport; however, there is a paucity of data in relation to golf-associated fractures, and the rate and timing of returning to golf. The aim of this review is to describe golf-associated fractures, including epidemiology, management, and timing of returning to golf following treatment. A literature search was performed using MEDLINE/PubMed, Embase, and Web of Science. Data were extracted and summarized in a narrative synthesis. A total of 436 articles were identified with an initial search of which 58 met the inclusion criteria. Twelve anatomical sites of golf swing-related fractures were identified, of which 10 sites were specific for stress fractures. The most common sites of golf swing-related stress fractures were the ribs followed by the hook of hamate. There was a common theme of delay to diagnosis, being initially assigned to a soft tissue injury. Most golfers with swing-related stress fractures were able to return to golf with the exception of osteoporotic associated vertebral stress fractures. Timing of returning to golf was between 4 and 12 months for most of the golfers with stress fractures following conservative management. Operative intervention was an option of hook of hamate nonunion, following a stress fracture, and tibial shaft stress fractures. Golf equipment-related fractures were not rare and were associated with major trauma and in some cases associated with significant persistent morbidity. Golf-related stress fractures commonly involve the ribs and hook of hamate; knowledge of this may aid in early diagnosis and appropriate treatment when symptomatic golfers are encountered. Although golf is a noncontact sport, fractures associated with golf equipment can be life changing, and safety training guidelines should be established.

Scapular Stress Fracture of the Inferior Angle in an Adolescent Swimmer

We present the case of a competitive swimmer who was 14 years, 9 months old and had a 4-month history of posterior shoulder pain. She was initially evaluated by her school's trainer and completed a 2-week rehabilitation program, but pain returned with return to swimming. After feeling a "pop" while swimming with an increase in associated shoulder pain, the patient presented for medical evaluation. Plain radiographs were read as unremarkable. A formal physical therapy program resulted in increased pain, and the patient returned to clinic within 2 weeks with pain out of proportion to examination. Magnetic resonance imaging at this time identified a stress fracture along the inferior angle of the scapula, prompting a complete shutdown of activity for 4 weeks with vitamin D and calcium supplementation. A physical therapy regimen was restarted at 6 weeks with complete resolution of symptoms and return to swimming at 3 months. This case report is important because it highlights a sports-related stress fracture of the inferior angle of the scapula, a finding not currently present in the literature, in a swimmer, a sport not yet associated with scapular stress fractures. [Orthopedics. 202x(xx):xx-xx.].

Fractures of the coracoid process: a systematic review

Background

Although fracture of the coracoid process (CF) used to be considered rare, it is now more commonly encountered due to increased awareness and advances in imaging methods. This review aimed to analyze reported cases of CF to determine its mechanism and appropriate treatment.

Methods

PubMed and Scopus were searched using the terms "scapula fracture" and "coracoid fracture." The inclusion criteria were English full-text articles concerning CF that described patient characteristics with appropriate images. The exclusion criteria included cases without appropriate images and those with physeal injury or nonunion. Citation tracking was conducted to find additional articles and notable full-text articles in other languages. Fractures were mainly classified using Ogawa's classification.

Results

Ninety-seven studies were identified, including 197 patients (131 men, 33 women; average age 37.0±16.9 years). CF was classified as type I in 77%, type II in 19%, and avulsion fracture at the angle in 5%. Concurrent shoulder girdle injuries included acromioclavicular injury in 33%, clavicular fracture in 17%, acromion or lateral scapular spine fracture in 15%, and anterior shoulder instability in 11%. Among patients with type I CF, 69% had multiple disruptions of the superior shoulder suspensory complex. Conservative treatment was applied in 71% of isolated type I CF, while surgical treatment was applied in 76% of type I CF with multiple disruptions. Although the evaluation methods varied, 60% of patients were followed up for more than 6 months, and the outcomes were generally satisfactory for both conservative and surgical treatments.

Conclusion

CF occurred commonly in the age group with higher social activity. The most common fracture type was type I. The possible mechanism of CF is violent traction of the attached muscles, except for avulsion fracture at the angle. Type I CF with multiple disruptions of the superior shoulder suspensory complex requires surgical treatment, whereas conservative care is recommended for isolated type I and type II CFs.

Distribution and Morphological Measurement of Bony Spurs on the Coracoid Process in a Chinese Population

Background

There are few studies on distributions or morphological measurements for bony spurs form at the attachment points of the ligaments and tendons on the coracoid process. The aim of this study was to investigate their most common sites and morphological characteristics, and to propose possible reasons.

Material/Methods

Scapulae with bony spurs on the coracoid process were selected from 377 intact and dry Chinese scapulae. The distribution, height, and transverse and longitudinal diameter of the bony spurs were measured in each coracoid process.

Results

We selected 71 scapulae, 36 left and 35 right, that had bony spurs, from 377 scapulae. The bony spurs were most commonly located at the attachment point of the superior transverse scapular ligament (STSL) (31, 23.66%), while the trapezoid ligament (TL) accounted for the smaller proportion (8, 6.11%). The TSL was the highest, with the minimum transverse and longitudinal diameter, while the TL had the greatest transverse and longitudinal diameters. Only the TSL and TL had a statistically significant difference between the left and the right bony spur regarding the longitudinal diameter (P<0.05).

Conclusions

Bony spurs are more likely to form at the attachment points of ligaments and tendons on the coracoid process, which has a greater risk of traction injuries or attachment points avulsion fractures.