Treatment of Coracoid Process Salter 1 Fracture
The recommended treatment for a coracoid process Salter 1 fracture consists of rest from throwing activities for a minimum of 6 weeks, followed by an additional 6 weeks of strengthening rehabilitation before return to activity, for a total of at least 3 months of rest from throwing.1
Understanding Coracoid Process Salter 1 Fractures
Coracoid process Salter 1 fractures are rare injuries that typically occur in skeletally immature patients. These fractures represent an overload injury to the physis (growth plate) and are similar to the condition known as "Little League shoulder" when they occur in young athletes.
Clinical Presentation
- Progressive worsening of upper arm pain with throwing activities
- Point of maximal tenderness over the proximal humerus or coracoid process
- Possible tenderness to palpation over the lateral aspect of the proximal humerus
- Radiographic widening of the physis on comparison views
Treatment Algorithm
Conservative Management (First-Line)
Complete Rest Phase (6 weeks minimum)
- Elimination of all throwing activities
- Immobilization with sling as needed for comfort
- Early mobilization as tolerated to prevent stiffness 2
- Pain management with appropriate analgesics
Rehabilitation Phase (6 additional weeks)
- Implementation of proper biomechanics
- Strengthening program focusing on:
- Rotator cuff muscles
- Periscapular muscles
- Core musculature
- Flexibility exercises for the shoulder capsule
Return to Activity Phase
- Gradual return to throwing after 3 months total rest
- Progressive throwing program with careful monitoring
Imaging Recommendations
- Initial radiographs to confirm diagnosis
- MRI may be beneficial to exclude other soft tissue injuries and confirm Salter 1 fracture pattern 1
- Follow-up radiographs to monitor healing
Evidence Analysis
The treatment recommendation is based primarily on guidelines for proximal humeral epiphysiolysis (Little League shoulder), which is considered analogous to a Salter-Harris type I injury to the proximal humeral physis 1. While specific literature on isolated coracoid process Salter 1 fractures is limited, case reports of coracoid fractures in adolescents have shown excellent outcomes with conservative management 2.
A systematic review of coracoid process fractures found that conservative treatment showed good results in most cases without associated disruptions of the Superior Shoulder Suspensory Complex (SSSC) 3. Another case report demonstrated good clinical outcomes following non-operative treatment of concomitant fractures of the coracoid process and distal clavicle 4.
Special Considerations
Surgical Indications
Surgery may be considered in cases with:
- Displacement >1 cm
- Painful nonunion
- Multiple disruptions of the SSSC
- High-demand athletes requiring expedited return to sport 5, 6
Pitfalls to Avoid
- Inadequate Rest Period: Returning to throwing activities too early can lead to non-union or chronic pain
- Missed Diagnosis: Coracoid fractures can be easily missed on standard radiographs; CT or MRI may be necessary for accurate diagnosis 1
- Neglecting Rehabilitation: Failure to address biomechanical issues and muscle imbalances may lead to recurrent injury
Monitoring and Follow-up
- Clinical evaluation every 2-4 weeks during recovery
- Radiographic assessment at 6 weeks and 3 months to confirm healing
- Assessment of throwing mechanics before return to sports
- Monitoring for any signs of growth disturbance or deformity
By following this treatment protocol, most patients with coracoid process Salter 1 fractures can expect excellent functional outcomes and complete recovery without the need for surgical intervention.