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Imaging of the Broken Raven's Beak (Coracoid Process Fractures)
Purpose or Learning Objective: (1) To review the anatomy of the coracoid process and its function; (2) to review the types of coracoid fractures and their classification; and (3) to present the radiologic appearance of the different fracture classifications in different modalities, including radiographs and computed tomography (CT).
Methods or Background: The coracoid process is a small hook-shaped bone located at the anterior lateral aspect of the scapular neck. It is a ligamentous and tendinous attachment point, provides cover to neurovascular structures, and is closely related to the rotator cuff interval. Coracoid fractures are rare and usually part of scapular or shoulder region fractures following direct trauma, sudden contractions, or repetitive stresses. The often undisplaced nature and satisfaction of a search lead to a frequently missed pathology.
Results or Findings: The two most frequently used classification schemes for coracoid fractures are the Ogawa and the Eyres classifications. The Ogawa scheme uses the coracoclavicular ligament as a focal point proximal to which is considered type I and distally is type II. The Eyres classification consists of types I to V depending on the fracture site, whether at the tip, midportion, basal, extends into the superior body of the scapula, or extends into the glenoid, respectively.
We demonstrate each type in radiographs and CT, with volume rendering and magnetic resonance imaging provided in some instances. Key imaging findings, pearls, and pitfalls are supplied throughout, with a brief summary of management options for each type.
Conclusion: The coracoid is a crucial anatomical component of the shoulder, with coracoid fractures easily overlooked. Therefore, knowledge of the classification schemes for fractures and how they look in different modalities is paramount to place the radiologist in an optimal position for guiding patient care.
Article published online:
26 May 2023
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