The coracoid process is a small hook-like structure on the lateral edge of the superior anterior portion of the scapula. Coracoid fractures are uncommon injuries. Most have been reported to occur in adults and in association with acromioclavicular dislocation or anterior shoulder dislocation [1] [2] . The first reports of isolated coracoid fractures date as far back as 1907 [3] . These fractures constitute only 1% of all fractures and 5% of shoulder fractures [4] . The mechanism of injury to the coracoid is usually trauma, usually as a result of road traffic accident or with direct impact on the shoulder girdle [5] . We herein present two cases of an isolated fracture of the coracoid process in 34- and 11-year-old males and emphasise the importance of careful evaluation of the patient to detect these rare injuries.

Coracoid fractures can be isolated or associated with injury. Associated conditions include acromioclavicular disruption, clavicular fracture, acromial fracture, scapular spine fracture, and glenoid fracture [5] [6] . Isolated fractures of the coracoid appear to be rare. The available literature on these injuries seems to comprise mostly case reports. To date, only two cases of isolated coracoid fractures in skeletally immature patients have been reported in the English-language literature.

Ogawa et al. divide these fractures into five groups but recommend 2 groups based on according the neighborring coracoclavicular ligaments. Type II is the tip fracture, Type I is on the scapular side of the ligaments. Ogawa et al. suggest that these typeI fractures require operative fixation [5] .

Standard anteroposterior and lateral scapular views do not readily demonstrate the base of coracoid fractures. Froimson described a technique in which the X-ray view is directed 45 degrees cephalad, which specifically displays the base of the coracoid. However, such a view is unlikely to be requested unless this rare diagnosis is considered [7] . Although this is an uncommon fracture, the authors recommend that an avulsion fracture be considered in patients with pain associated with the coracoid process upon palpation. Computed tomography or Froimson views should be ordered in these patients.

Based on our presented case reports, isolated fractures of the coracoid in the adolescent group can be treated successfully by conservative means. If any doubt that the presence of fractures or displacement amount we recommend that CT examination. Shoulder arm sling should be used to relieve pain and, more importantly, it should be used to prevent displacement. Do not hesitate CT examination because nondeplated fracture diagnosis should be missed. The treatment of an isolated coracoid process fracture depends on the location and displacement of the fracture. Nonoperative treatment of the fracture has been documented, especially when minimally displaced, as in our cases [5] [8] [9] . Most fractures occur at the base of the coracoid process, and displacement is usually minimal because the coracoclavicular ligaments tend to maintain the position of the fragments. The fracture surface is relatively large, and union can be expected even with comminution [5] [6] . Some authors have stated that coracoid fractures should be reduced when displacement is present or to prevent possible resultant disability. Serious displacement usually only occurs when the coracohumeral ligament or coracoclavicular ligament is torn [10] . Accepted indications for surgical treatment are painful nonunion, >1-cm displacement, concomitant scapula fracture, and superior shoulder suspensory complex injuries.

Operative treatment might not be necessary for isolated nondisplaced coracoid fractures because both of our patients had excellent results with a simple sling and early physiotherapy. Early physiotherapy includes pendular exercises for 3 weeks and active shoulder exercises thereafter. At 6 weeks, shoulder-strengthening exercises could be started.

Isolated coracoid fractures can easily be missed on plain roentgenographs, so physical examination combined with computed tomography in suspected cases is essential to diagnose these rare injuries in the emergency setting. It is also crucial to perform a detailed neurological examination because coracoid fractures, especially when displaced, can be associated with brachial plexus compression.

Informed consent was taken for this work.

The authors declare that they have no conflict of interests.

FatihTürkmensoy,TayyarOz,MuratDemiroglu,Afsar T.Ozkut,AkifAkcal,BulentKilic, (2015) Isolated Two Non-Displaced Coracoid Fracture Treated with Conservative Means: Report of Two Cases. Open Journal of Orthopedics,05,253-257. doi: 10.4236/ojo.2015.59034