Orthogonal radiographic technique for radiographic visualization of coracoid process fractures and pericoracoid fracture extensions.

Abstract

Radiographic visualization of coracoid process fractures is difficult due to the complex and variable 3-dimensional orientation of coracoid pillars. Failure to suspect an injury on preliminary radiographs has been described as a major reason for suboptimal management of these fractures. We describe a standardized method of patient positioning and radiographic beam angulation (orthogonal radiographic technique), to provide two roentgenographic views (Bhatia views) for visualization of individual coracoid pillars. The "superior pillar view (SPV)" demonstrates fractures involving the superior pillar, and peri-coracoid extension into the suprascapular notch; the "inferior pillar view (IPV)" is useful for fractures involving the inferior pillar (coracoid base), and their extension into the glenoid articular surface. Radiographs of 19 consecutive coracoid fractures, that were imaged using the described technique, were analyzed, and the results were used to suggest a radiographic method of grouping these injuries.