Journal of Avian Medicine and Surgery 28(4):304–308, 2014

Ó 2014 by the Association of Avian Veterinarians

Coracoid Fractures in Wild Birds: A Comparison of Surgical

Repair Versus Conservative Treatment
T. Franciscus Scheelings, BVSc, MVSc, MANZCVSc (Med Aust Wildl), Dipl ECZM

Abstract: Medical records of wild bird admissions to the Australian Wildlife Health Centre at
Healesville Sanctuary were analyzed for cases of unilateral coracoid fractures with known final
outcomes. Forty-seven birds, comprising 13 species, fit these criteria. Of those birds, 18 were
treated conservatively with analgesia and cage rest without coaptation bandaging, and 29 were
treated with surgical correction of the fracture. Of the conservatively managed birds, 89% (16 of
18) were released back into the wild. Conversely, 34% (10 of 29) of the surgically managed birds
were released. Treatment success for release differed significantly between treatment groups (P ,
.001). Intraoperative death from concurrent trauma was the major reason that surgically treated
birds were not released. Given the high risks associated with surgical treatment and the high
success rate of conservative management, cage rest without surgery appears prudent when
managing coracoid injuries in birds.
Key words: trauma, coracoid, surgery, cage rest, rehabilitation, release, avian

Introduction with coracoid injuries treated both conservatively

The thoracic girdle of birds comprises the
coracoid and the scapula bones as well as the
fused clavicles.1,2 The coracoid bones act as
supporting struts for the pectoral limbs by
connecting them to the sternum.2 This buttressing
prevents collapse of the thoracic wall that would
otherwise occur during contraction of the pectoral
muscles during downward strokes of the wings.1
Additionally, the coracoids help to suspend the
sternum during gliding, which supports the vis-
cera.1
Coracoid injuries commonly occur when birds
crash into solid objects, such as walls, windows, or
cars.3,4 They are more likely to occur with frontal
collisions when the wings are fanned.4 Affected
birds are unable to gain lift, and diagnosis is
confirmed by palpation of the pectoral girdle and
radiography.5
Much debate surrounds the management strat-
egies for coracoid injuries in birds, with some
authors advocating surgical correction5–8 and
others recommending conservative treatment.9,10
This article describes the clinical outcomes of birds
From the Australian Wildlife Health Centre, Healesville
Sanctuary, Healesville, VIC 3777, Australia.
and with surgical intervention.
Materials and Methods
The medical records of 2523 birds of common
species admitted to the Australian Wildlife Health
Centre (AWHC), Healesville Sanctuary, between
January 2007 and June 2013 were examined.
Inclusion criteria were birds with unilateral cora-
coid trauma and a known final outcome. Birds
with evidence of other trauma were excluded from
analysis. Birds were selected to treatment groups
based on clinician preference for surgical or
nonsurgical management. No consideration was
given to species, weight, extent of injury, or clinical
signs in selection for treatment group.
Birds were assessed for concurrent injuries by
results of a combination of routine physical
examination and test flying, examination under
general anesthesia, and whole body radiographs.
For birds treated conservatively for coracoid
injuries, general anesthesia was induced by face-
mask with 5% isoflurane at the time of initial
examination, and the injury was confirmed by
radiography (Fig 1). An intravenous bolus of
compound sodium lactate (2% of body weight;
Baxter Healthcare Pty Ltd, Toongabbie, NSW,

304
 SCHEELINGS—CORACOID FRACTURES IN WILD BIRDS
Figure 1. (A) Ventrodorsal view of a laughing kookaburra with a midshaft fracture of the coracoid (arrow). (B) Lateral
view of the bird described in (A).
Australia) was then administered, and analgesia
was provided with a combination of tramadol (5–
30 mg/kg [dependent on species] IM; Tramal 100,
CSL Biotherapies Pty Ltd, Parkville, VIC, Aus-
tralia) and meloxicam (1 mg/kg IM). Analgesics
with the same drug combination were continued
for 3 days after presentation but given orally twice
daily. Birds were confined to a small cage for 3
weeks with no bandaging or physiotherapy and fed
species-specific diets. All birds in this treatment
group were managed without regard to variables of
patient size, wing loading ratio, or degree of
fracture displacement. For surgical correction of
coracoid injuries, initial triage was identical to that
of the conservative treatment group. Birds were
then stabilized for 2 days after presentation at
which time surgery was performed by the methods
described by Holz.5 Postsurgical care was then
identical to that of conservatively treated birds.
After 3 weeks of convalescence, each bird was
anesthetized and radiographed to determine the
extent of callus formation and to assess fracture
stability (Fig 2). For surgically managed birds, the
intramedullary pin was removed at this stage,
provided adequate healing had occurred. Each bird
in both treatment groups then entered a period of
flight training and rehabilitation before release to
the wild. Birds were considered fit for release if
they could complete 10 laps of a 10-m wind tunnel
305
with their respiratory rate returned to the resting
rate within 30 seconds.11
Treatment outcomes were analyzed by the
Fisher’s exact test. The a level of statistical
significance was set at P  .05. Comparisons
between species were not possible because of low
individual numbers.
Results
Forty-seven birds satisfied these inclusion crite-
ria. Species included in this study were laughing
kookaburra (Dacelo novaeguineae; n ¼ 11), rain-
bow lorikeet (Trichoglossus haematodus; n ¼ 6),
musk lorikeet (Glossopsitta concinna; n ¼ 1),
crimson rosella (Platycercus elegans; n ¼ 9), eastern
rosella (Platycercus eximius; n ¼ 1), galah (Eolo-
phus roseicapilla; n ¼ 3), yellow-tailed black
cockatoo (Calyptorhynchus funereus; n ¼ 1),
Australian magpie (Cracticus tibicen; n ¼ 4), tawny
frogmouth (Podargus strigoides, n ¼ 7), southern
boobook owl (Ninox novaeseelandiae; n ¼ 1),
Australian hobby (Falco longipennis; n ¼ 1),
peregrine falcon (Falco peregrinus; n ¼ 1) and
brown goshawk (Accipiter fasciatus; n ¼ 1).
Of the 47 birds, 38% (18) were treated conser-
vatively, whereas the remaining 62% (29) were
treated surgically (Table 1). Of the birds treated
conservatively, 89% (16 of 18) were released. The 2
birds (11%) that were not released died within 24
306 JOURNAL OF AVIAN MEDICINE AND SURGERY

Figure 2. (A) Ventrodorsal and (B) lateral views of the same bird described in Figure 1, at 3 weeks after admission.
Despite the obvious malalignment (arrow), the fracture was stable. The bird was able to fly well, and it was released 6
weeks after admission.

hours after presentation, despite triage. On post-
mortem examination, both birds had extensive free
blood in the coelomic cavity and contusions to
both lungs.
Of the birds treated surgically, 34% (10 of 29)
were released, 14% (4 of 29) were not released
because of an inability to fly appropriately, and
52% (15 of 29) died intraoperatively. Postmortem
examinations of deceased birds revealed a range of
soft tissue traumatic injuries that were the probable
cause of intraoperative death. These soft tissue
lesions were consistent with those of birds that had
been treated conservatively and with those other
birds admitted to the AWHC, but not included in
this study, that died because of thoracic trauma.
Therefore, these lesions were not considered a
direct result of surgical intervention.
For all species examined, 3 weeks was adequate
time for stable callous to form, and no birds
required further cage rest. Birds treated conserva-
tively were more likely to be released than were
surgically treated birds (P , .001). The average

Table 1. Outcomes of wild birds with coracoid injuries treated at the Australian Wildlife Health Centre (Healesville,
VIC, Australia) from 2006–2013.

Conservative treatment, No. Surgical treatment, No.

Species Released Not released Released Not released
Australian hobby 1 — — —
Australian magpie 2 — 1 1
Brown goshawk — — 1 —
Crimson rosella 3 2 — 4
Eastern rosella 1 — — —
Galah — — 1 2
Laughing kookaburra 2 — 5 4
Musk lorikeet 1 — — —
Peregrine falcon — — 1 —
Rainbow lorikeet 2 — — 4
Southern boobook owl — — — 1
Tawny frogmouth 3 — 1 3
Yellow-tailed black cockatoo 1 — — —
Total (%) 16 (89%) 2 (11%) 10 (34%) 19 (66%)
 SCHEELINGS—CORACOID FRACTURES IN WILD BIRDS
duration of rehabilitation was 26 days (64.6 days)
for all birds, and there was no difference in
duration of rehabilitation between treatment
groups (P ¼ .75). Duration of rehabilitation
between species could not be compared because
of low individual numbers.
Discussion
The surgical technique for repair of coracoid
injuries in birds has been well described and is
generally recommended for birds .300 g in body
weight.1,4,12 In smaller birds, coaptation with a
figure-of-eight bandage to immobilize the wing to
the body wall may result in adequate healing.4,12
However, prolonged immobilization of wings in
this manner may result in patagial contraction and
a decrease in elbow function.13 In this investiga-
tion, external coaptation was not applied to any
patient. Absence of external coaptation did not
increase fracture-healing time nor did it result in a
loss of function or hinder return to the wild. This
method of treatment, without coaptation, com-
bined with 3 days of multimodal analgesia, resulted
in rapid return to natural behavior in wild birds in
this study, as evidenced by normal body posture
and good appetite. Although some clinicians
recommend bandaging and regular physiotherapy
for coracoid injuries, in this author’s experience,
that method does not necessarily improve return to
function for this type of injury. The large muscle
mass surrounding the coracoid bones in avian
patients likely provides enough stability to negate
the need for external coaptation. The results of this
study indicate that analgesia and cage rest without
bandaging appear to be adequate methods of
managing coracoid injuries in a variety of avian
species. Future research should focus on the
benefits of coaptation bandaging versus nonban-
daging in management of coracoid injuries in
birds.
Body size has been suggested 5 to be an
inaccurate predictor of the success of conservative
treatment for coracoid injuries in birds, whereas
aspect ratio and wing loading have been suggested5
as better indicators. The results of this investiga-
tion do not support the first part of this hypothesis
because 4 of the species treated conservatively
(yellow-tailed black cockatoo, Australian magpie,
tawny frogmouth, and laughing kookaburra) had
mean body weights .300 g.14–16 Wing loading was
not considered in managing any of the cases in this
study, and many clinicians do not consider it
important.9
307
Surgical correction of coracoid injuries can be
difficult because patients are often further com-
promised by substantial soft tissue injuries,3 which
may increase the anesthetic risk. These traumatic
injuries include large volumes of free blood in the
coelomic cavity, punctures or tears to the heart,
lung contusions, and free blood in the respiratory
system (AWHC postmortem records). Other po-
tential complications associated with surgical
correction are advancing intramedullary pins into
the coelomic cavity and penetrating important
soft-tissue structures, damage to the shoulder joint
resulting in periarticular fibrosis, shoulder joint
ankylosis, and impaired shoulder function.17 Al-
though similar complications have been reported
to occur in cases of coracoid injuries managed
without surgery, these sequelae were not observed
in any of the cases in this investigation.
In this investigation, the natural history of
individual species was not taken into account for
rehabilitation. Ideally, species-specific training
regimes that accurately mimic wild flight patterns
and encourage birds to develop natural behaviors,
such as prey apprehension, should be used.
However, given the myriad of species that are
presented to the AWHC each year for rehabilita-
tion, this was not practical. Therefore, a standard
approach to rehabilitation, which has proven
effective for 2 different avian species, was used.11
Further research, such as postrelease monitoring of
rehabilitated birds, is required to ascertain whether
such practices result in good survivorship for all
species.
Given the propensity of coracoid injuries in
birds to be accompanied by other traumatic
injuries and the risks that those injuries pose to
prolonged general anesthesia, recommending that
coracoid injuries be managed conservatively would
seem prudent. Standard principles of emergency
medicine should be used for all birds that have
acute traumatic injuries and should include fluid
support, analgesia, antibiotic therapy when appro-
priate, and warmth.18–20 If birds survive the first 48
hours after traumatic coracoid injury, the results of
this investigation indicate that the prognosis for
rehabilitation and release are excellent when birds
are treated with cage rest and pain management
alone, without coaptation bandaging or surgical
intervention.
References
1. Orosz SE, Ensley PK, Haynes CJ. Avian Surgical
Anatomy—Thoracic and Pelvic Limbs. Philadelphia,
PA: WB Saunders; 1992.
308 JOURNAL OF AVIAN MEDICINE AND SURGERY
2. King AS, McLelland J. Birds: Their Structure and
Function. Eastbourne, UK: Bailliere Tindall; 1984.
3. Cousins RA, Battley PF, Gartrell BD, Powlesland
RG. Impact injuries and probability of survival in a
large semiurban endemic pigeon in New Zealand,
Hemiphaga novaeseelandiae. J Wildl Dis. 2012;
48(3):567–574.
4. Martin H, Ritchie BW. Orthopedic surgical tech-
niques. In: Ritchie BW, Harrison GJ, Harrison LR,
eds. Avian Medicine: Principles and Application.
Lake Worth, FL: Wingers Publishing Inc; 1994:
1137–1169.
5. Holz PH. Coracoid fractures in wild birds: repair
and outcomes. Aust Vet J. 2003;81(8):469–471.
6. Sanchez-Migallon D, Bubenik LJ, Lauer SK, et al.
Repair of a coracoid luxation and a tibiotarsal
fracture in a bald eagle (Haliaeetus leucocephalus). J
Avian Med Surg. 2007;21(3):188–195.
7. Bennett RA, Kuzma AB. Fracture management in
birds. J Zoo Wildl Med. 1992;23(1):5–38.
8. MacCoy DM. Treatment of fractures in avian
species. Vet Clin North Am Small Anim Pract.
1992;22(1):225–238.
9. Redig PT, Francisco ON, Froembling M, Martinez
LC. Coracoid fracture management in raptors:
assessment of the conservative approach. Proc Annu
Conf Assoc Avian Vet. 2009:351.
10. Orosz SE, Ponder JB. Cutting to the chase—part 1:
wing fractures. Proc North Am Vet Conf. 2012:
1306–1308.
11. Mason PF. Indicators of Rehabilitative Success in
Hospital Admissions of Kookaburras and Crimson
Rosellas [master’s thesis]. Parkville, Australia: Uni-
versity of Melbourne; 2006.
12. Orosz SE. Clinical considerations of the thoracic
limb. Vet Clin North Am Exot Anim Pract. 2002;
5(1):31–48.
13. Redig PT. The use of an external skeletal fixator-
intramedullary pie tie-in (ESF-IM fixator) for
treatment of longbone fractures in raptors. In:
Lumeij JT, Remple JD, Redig PT, et al, eds. Raptor
Biomedicine III Including Bibliography of Diseases of
Birds of Prey. Lake Worth, FL: Zoological Educa-
tion Network; 2000:239–253.
14. Marchant S, Higgins PJ. Raptors to lapwings. In:
Marchant S, Higgins PJ, ed. Handbook of Austra-
lian, New Zealand and Antarctic Birds. Vol 2. South
Melbourne, Australia: Oxford University Press;
2007:21–320.
15. Higgins PJ. Parrots to dollarbird. In: Higgins PJ,
Peter JM, Cowling SJ, eds. Handbook of Australian,
New Zealand and Antarctic Birds. Vol 4. South
Melbourne, Australia: Oxford University Press;
2006:25–646.
16. Higgins PJ, Peter JM, Cowling SJ. Boatbills to
starlings. In: Higgins PJ, Peter JM, Cowling SJ, eds.
Handbook of Australian, New Zealand and Antarctic
Birds. Vol 7. South Melbourne, Australia: Oxford
University Press; 2006:396–772.
17. Bennett RA. Orthopedic surgery. In: Altman RB,
Clubb SL, Dorrestein GM, Quesenberry K, eds.
Avian Medicine and Surgery. Philadelphia, PA: WB
Saunders; 1997:733–767.
18. Bowles H, Lichtenberger M, Lennox A. Emergency
and critical care of pet birds. Vet Clin North Am
Exot Anim Pract. 2007;10(3):345–394.
19. Graham J, Heatley JJ. Emergency care of raptors.
Vet Clin North Am Exot Anim Pract. 2007;10(2):
395–418.
20. de Matos R, Morrisey JK. Emergency and critical
care of small psittacines and passerines. Semin Avian
Exot Pet Med. 2005;14(2):90–105.
Copyright of Journal of Avian Medicine & Surgery is the property of Association of Avian
Veterinarians and its content may not be copied or emailed to multiple sites or posted to a
listserv without the copyright holder's express written permission. However, users may print,
download, or email articles for individual use.