The coracoglenoid notch: anatomy and clinical significance

Abstract

Introduction

The superior surface of the anatomical neck is presented in the classification of scapular fractures as a 2-cm-long structure, which does not correspond to reality. This issue has not yet been adequately addressed in the literature. The aim of the study was to assess the variability of a notch between the upper rim of the glenoid and the coracoid base, the so-called coracoglenoid notch (CGN), and its clinical significance.

Materials and methods

The study was based on the examination of 204 dry bone specimens of adult scapulae (92 male and 112 female). We have determined quantitative criteria for the evaluation of the CGN type, measuring the offset of anatomical neck using a digital caliper. The findings were compared with 3D CT reconstructions of fractures of the scapular anatomical neck.

Results

Three basic types of CGN have been identified: type A—a well-developed notch in 31%, type B—a shallow notch in 53% and type C—an absent notch in 16%. No significant difference in CGN was found between the sexes, or between the right and left sides. When compared with our six cases of the anatomical neck fracture of the scapula, two patients displayed CGN type A and type B, respectively; but in four patients, it was impossible to distinguish between types A and B.

Conclusion

The study has documented a high variability of CGN. Its presentation in the classification schemes does not correspond to anatomical reality. The presence of a deep, or shallow, notch may constitute an anatomical predisposition to a fracture of the anatomical neck.

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References

  1. 1.

    Anetzberger H, Putz R (1996) The scapula: principles of construction and stress. Acta Anat 156:70–80. https://doi.org/10.1159/000147830

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Armitage BM, Wijdicks CA, Tarkin IS, Schroder LK, Marek DJ, Zlowodzki M, Cole PA (2009) Mapping of scapular fractures with three-dimensional computed tomography. J Bone Jt Surg Am 91-A:2222–2228. https://doi.org/10.2106/jbjs.h.00881

    Article  Google Scholar 

  3. 3.

    Arts V, Louette L (1999) Scapular neck fractures; an update of the concept of floating shoulder. Injury 30:146–148. https://doi.org/10.1016/s0020-1383(98)00231-9

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Bartoníček J, Cronier P (2010) History of the treatment of scapular fractures. Arch Orthop Trauma Surg 130:83–92. https://doi.org/10.1007/s00402-009-0884-y

    Article  PubMed  Google Scholar 

  5. 5.

    Bartoníček J, Tuček M, Frič V (2013) Fractures of the anatomical neck of the scapula. Two cases and review of the literature. Arch Orthop Trauma Surg 133:1115–1119. https://doi.org/10.1007/s00402-013-1783-9

    Article  PubMed  Google Scholar 

  6. 6.

    Bartoníček J, Tuček M, Frič V, Obruba P (2014) Fractures of the scapular neck. Diagnosis—classifications—treatment. Int Orthop 38:2163–2173. https://doi.org/10.1007/s00264-014-2434-7

    Article  PubMed  Google Scholar 

  7. 7.

    Bartoníček J, Tuček M, Klika D, Chochola A (2016) Pathoanatomy and computed tomography classification of glenoid fossa fractures based on 90 patients. Int Orthop 40:2383–2392. https://doi.org/10.1007/s00264-016-3169-4

    Article  PubMed  Google Scholar 

  8. 8.

    Bartoníček J (2015) Scapular fractures. In: Court-Brown CH, Heckman AD, McQueen MM, Ricci WM, Tornetta P (eds) Rockwood and Green’s fractures in adults, 8th edn. Wolters Kluwer, Philadelphia, pp 1475–1501

    Google Scholar 

  9. 9.

    Burke CS, Roberts CS, Nyland JA, Radmacher PG, Acland RD, Voor MJ (2006) Scapular thickness—implications for fracture fixation. J Shoulder Elb Surg 15:645–648. https://doi.org/10.1016/j.jse.2005.10.005

    Article  Google Scholar 

  10. 10.

    Casier SJ, Van den Broecke R, Van Houcke J, Audenaert E, De Wilde LF, Van Tongel A (2018) Morphologic variations of the scapula in 3-dimensions: a statistical shape model approach. J Shoulder Elb Surg 27:2224–2231. https://doi.org/10.1016/j.jse.2018.06.001

    Article  Google Scholar 

  11. 11.

    Decoulx P, Minet P, Lemerle (1956) Fractures de l´omoplate. Lille Chir 11:217–227

    Google Scholar 

  12. 12.

    Donders JCE, Prins J, Kloen P, Streekstra GJ, Cole PA, Kleipool RP, Dobbe JGG (2020) Three-dimensional topography of scapular nutrient foramina. Surg Radiol Anat 42(8):887–892. https://doi.org/10.1007/s00276-020-02458-y

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Ebraheim NA, Xu R, Haman SP, Mielder JD, Yeasting RA (2000) Quantitative anatomy of the scapula. Am J Orthop 29:287–292

    CAS  PubMed  Google Scholar 

  14. 14.

    Edelson JG (1992) Anatomy of the coraco-acromial arch. J Bone Jt Surg Br 74-B:589–594

    Article  Google Scholar 

  15. 15.

    Edelson JG (1996) Variations in the anatomy of the scapula with reference to the snapping scapula. Clin Orthop Relat Res 322:111–115

    Article  Google Scholar 

  16. 16.

    Euler E, Rüedi T (1996) Skapulafraktur. In: Habermeyer P, Schweiberer L (eds) Schulterchirurgie. Urban und Schwarzenberg, München, pp 261–272

    Google Scholar 

  17. 17.

    Fojtík P, Kostlivý K, Bartoníček J, Naňka O (2020) The fibular notch—an anatomical study. Surg Radiol Anat. https://doi.org/10.1007/s00276-020-02476-w

    Article  PubMed  Google Scholar 

  18. 18.

    Frazer JES (1946) The anatomy of the human skeleton. Churchill, London

    Google Scholar 

  19. 19.

    Galina M, Santamaria E, Doro T (1998) Anthropometry of the scapula: clinical and surgical consideration. J Shoulder Elb Surg 7:284–291. https://doi.org/10.1016/s1058-2746(98)90057-x

    Article  Google Scholar 

  20. 20.

    Goss TP (1994) Fractures of the glenoid neck. J Shoulder Elb Surg 3:42–52. https://doi.org/10.1016/S1058-2746(09)80007-4

    CAS  Article  Google Scholar 

  21. 21.

    Gumina S, Postachini F, Orsina L, Cinotti G (1999) The morphometry of coracoid process—its aetiologic role in subcoracoid impingement syndrome. Int Orthop 23:198–201. https://doi.org/10.1007/s002640050349

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Hardegger F, Simpson LA, Weber BG (1984) The operative treatment of scapular fractures. J Bone Jt Surg Br 66-B:725–731

    Article  Google Scholar 

  23. 23.

    Hovelacque A (1933) Ostéologie. Fascicule 1. Doin & Cie, Paris, pp 7–22

    Google Scholar 

  24. 24.

    Ideberg R, Grevsten S, Larsson S (1995) Epidemiology of scapula fractures. Acta Orthop Scand 66:395–397. https://doi.org/10.3109/17453679508995571

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Jaeger M, Lambert S, Südkamp NP, Kellam JF, Madsen JE, Babst R, Andermahr J, Li W, Audigé L (2013) The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapular fracture classification system: focus on glenoid fossa involvement. J Shoulder Elb Surg 22:512–520

    Article  Google Scholar 

  26. 26.

    Jeong GK, Zuckerman JD (2005) Scapula fractures. In: Zuckerman JD, Koval KJ (eds) Shoulder fractures. Thieme, New York, pp 199–222

    Google Scholar 

  27. 27.

    Karelse A, Kegels L, de Wilde L (2005) The pillars of the scapula. Clin Anat 20:392–399. https://doi.org/10.1002/ca.20420

    Article  Google Scholar 

  28. 28.

    Kelly DP, Roberts ZV (2016) Case report of an isolated fracture of the anatomic neck of the scapula. Case Stud Surg 2:23–26

    Article  Google Scholar 

  29. 29.

    Li MM, Goetti P, Sandman E, Rouleau DM (2020) Influence of coracoid anatomy on the location of glenoid rim defects in anterior shoulder instability: 3D CT-scan evaluation of 51 patients. Surg Radiol Anat 42(8):895–901. https://doi.org/10.1007/s00276-020-02492-w

    Article  PubMed  Google Scholar 

  30. 30.

    Mallon WJ, Brown HR, Vogler JB, Martinez S (1982) Radiographic and geometric anatomy of the scapula. Clin Orthop Relat Res 277:142–154

    Google Scholar 

  31. 31.

    Neuhaus V, Bot AGJ, Guitton TG, Ring DC (2014) Scapula fractures: interobserver reliability of classification and treatment. J Orthop Trauma 28:124–129. https://doi.org/10.1097/BOT.0b013e31829673e2

    Article  PubMed  Google Scholar 

  32. 32.

    Orthopaedic Trauma Association (2007) Fracture and dislocation compendium. Scapula fractures. J Orthop Trauma 21(Suppl 1):S68–S71

    Google Scholar 

  33. 33.

    Orthopaedic Trauma Association (2018) Fracture and dislocation compendium. Scapula fractures. J Orthop Trauma (Suppl) 32:S101–S104. https://doi.org/10.1097/BOT.0000000000001070

    Article  Google Scholar 

  34. 34.

    Reckova M, Rosengarten C, de Almeida A, Stanley CP, Wessels A, Gourdie R, Thompson RP, Sedmera D (2003) Hemodynamics is a key epigenetic factor in development of the cardiac conduction system. Circ Res 93(1):77–85. https://doi.org/10.1161/01.RES.0000079488.91342.B7

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Simon P, Diaz M, Cusick M, Santoni B, Frankle M (2018) 3D image-based morphometric analysis of the scapular neck length in subject undergoing reverse shoulder arthroplasty. Clin Anat 31:43–55. https://doi.org/10.1002/ca.22911

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Singh N, Chauhan P, Loh HK, Kohli M, Suri RK (2018) Enigma of scapular foramen and tunnels: an untold story. Surg Radiol Anat 40:327–332. https://doi.org/10.1007/s00276-017-1931-y

    Article  PubMed  Google Scholar 

  37. 37.

    Sinha RR, Kumar B, Kulkarni JP (2018) Morphometry and morphology of glenoid fossa of scapula. Indian J Clin Anat Physiol 5:303–307

    Article  Google Scholar 

  38. 38.

    Tanton J (1915) Fractures en général-Fractures des membres supérieurs. JB Baillière, Paris, pp 785–819

    Google Scholar 

  39. 39.

    Totlis T, Konstantidinis GA, Karanassos MT, Sofidis G, Anastasopoulos N, Natsis K (2014) Bony structures related to snapping scapula: correlation to gender, side and age. Surg Radiol Anat 36:3–9. https://doi.org/10.1007/s00276-013-1130-4

    Article  PubMed  Google Scholar 

  40. 40.

    Tuček M, Bartoníček J, Frič V (2011) Osseous anatomy of scapula: its importance for classification of scapular body fractures. Ortopedie 5:104–109

    Google Scholar 

  41. 41.

    Alfaro-Gomez U, Fuentes-Ramirez LD, Chavez-Blanco KI, Vilchez-Cavazos JF, Zdilla MJ, Elizondo-Omana RE, Guerra-Leal JD, Elizondo-Riojas G, Pinales-Razo R, Guzman-Lopez S, Quiroga-Garza A (2020) Anatomical variations of the acromial and coracoid process: clinical relevance. Surg Radiol Anat 42(8):877–885. https://doi.org/10.1007/s00276-020-02497-5

    Article  PubMed  Google Scholar 

  42. 42.

    von Schroeder HP, Kuiper SD, Botte MJ (2001) Osseous anatomy of the scapula. Clin Orthop Relat Res 383:131–139. https://doi.org/10.1097/00003086-200102000-00015

    Article  Google Scholar 

  43. 43.

    Zhang L, Guo X, Liu Y, Ou M, Lin X, Qi J, Xu Y, Wang G, Fu S (2019) Classification of the superior angle of the scapula and its correlation with the suprascapular notch: a study on 303 scapulae. Surg Radiol Anat 41:377–383. https://doi.org/10.1007/s00276-018-2156-4

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors wish to thank Prof. Chris Colton MB BS FRCS and Ludmila Bébarová PhD for their assistance in editing of the manuscript.

Funding

Supported by IP DZRVO MO1012.

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Correspondence to Ondřej Naňka.

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Strnad, T., Bartoníček, J., Naňka, O. et al. The coracoglenoid notch: anatomy and clinical significance. Surg Radiol Anat 43, 11–17 (2021). https://doi.org/10.1007/s00276-020-02527-2

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Keywords

  • Scapular fractures
  • Anatomy of the scapula
  • Fractures of anatomical neck of scapula
  • Coracoglenoid notch