New System for the Classification of Epiphyseal Separation of theCoracoid Process: Evaluation of Nine Cases and Review ofthe Literature

Epiphyseal separation of the coracoid process (CP) rarely occurs in adolescents. In this retrospective caseseries, we reviewed the data of nine patients treated at our center and those of 28 patients reported in the literature. )is injury canbe classified into three types according to the injured area: Type I, base including the area above the glenoid; Type II, centerincluding the coracoclavicular ligament (CCL); and Type III, tip with the short head of the biceps and coracobrachialis, as well asthe pectoralis minor.Patients/Participants. A total of 37 patients were included in the analysis. Data on sex, age, cause andmechanism of injury, separation type, concomitant injury around the shoulder girdle, treatment, and functional outcomes wereobtained.Main Outcome Measurements and Results. Type I is the most common type. )e cause of injury and associated injuryaround the shoulder girdle were significantly different between Type I, II, and III fractures. )e associated acromioclavicular (AC)dislocation and treatment were significantly different between Type I and III fractures. Our new classification system reflects theclinical features, imaging findings, and surgical management of epiphyseal separation of the CP. Type I and II fractures are mostlyassociated with AC dislocation and have an associated injury around the shoulder girdle. Type III fractures are typically caused byforceful resisted flexion of the arm and elbow. Although the latter are best managed surgically, whether conservative or surgicalmanagement is optimal for Type I and II fractures remains controversial.Conclusions. We noted some differences in the clinicalcharacteristics depending on the location of injury; therefore, we aimed to examine these differences to develop a new system forclassifying epiphyseal separation of the CP. )is would increase the clinicians’ awareness regarding this injury and lead to thedevelopment of an appropriate treatment.