Clinical
Coracoid fractures in wild birds: repair and outcomes
PH HOLZ
Healesville Sanctuary, PO Box 248, Healesville, Victoria 3777
Objective To describe the surgical repair of the fractured
avian coracoid and compare release rates back to the wild for
birds treated surgically with those treated conservatively.
Design Medical records of 17 birds presented to
Healesville Sanctuary with fractured coracoids were exam-
ined retrospectively. Nine birds were treated conservatively
and eight birds were treated surgically. Release rates back to
the wild were compared between the two groups.
Results Of the nine birds treated conservatively two were
released back to the wild. Of the eight birds treated surgically
six were released back to the wild.
Conclusions In this study greater success at returning
birds with fractured coracoids to the wild was achieved with
surgical repair than conservative treatment. Surgical repair is
recommended for birds intended to be released back into the
wild.
Aust Vet J 2003;81:469-471
T
he coracoid is a large bone that, along with the
scapula and clavicle, makes up the avian thoracic
girdle. 1 It articulates proximally with the sternum
and distally with the humerus, clavicle and scapula (Figure
1). The coracoid acts as a strut keeping the wing away from
the sternum during flight. In this way it assists the ribs in
preventing the collapse of the thoracic cage, which could be
caused by contraction of the pectoral muscles during the
powerful downstroke of the wings. During gliding the cora-
coid helps to suspend the sternum, which acts as a platform
to support the viscera.1
Coracoid fractures occur when the thorax collides with a
solid object. Diagnosis can be difficult, as affected birds
may only have a slight wing droop or no droop at all,
however, they are unable to obtain lift. As a result of the
coracoid being under compression both at rest and during
pectoral muscle contraction, diaphyseal fractures are
frequently overridden. Healing without fixation leads to a
malunion and shortened bone. Intuitively it would be
expected that this would hinder the bird’s ability to fly,
however, the severity of this handicap is dependent on the
individual species, their anatomy and flying style.
This paper describes the surgical technique used for
repairing coracoid fractures and compares release rates back
into the wild of birds treated conservatively with those
treated surgically. The aim was to determine if the imperfect
repair that occurs in birds treated conservatively translated
into a clinically recognisable difference in flying capability.
Materials and methods
Healesville Sanctuary medical records were examined for
wild birds with coracoid fractures and known final
outcomes. Seventeen birds satisfied these two criteria. Nine
of these - one galah (Cacatua roseicapilla), one black falcon
(Falco subniger), two Australian hobbies (Falco longipennis),
Aust Vet J Vol 81, No 8 August 2003
one peregrine falcon (Falco peregrinus), one brown falcon
(Falco berigora), one wedge-tailed eagle (Aquila audax), one
brown goshawk (Accipiter fasciatus), and one rainbow lori-
keet (Trichoglossus haematodus) - had been treated conserva-
tively by cage rest alone with no bandaging. Eight birds -
two kookaburras (Dacelo novaeguineae), three Australian
hobbies, two brown goshawks, and one collared sparrow-
hawk (Accipiter cirrhocephalus) - were treated surgically.
Diagnosis of a coracoid fracture was confirmed radio-
graphically. In large birds the fracture may be palpated by
inserting a finger behind the clavicle, however, a radiograph
was mandatory both to confirm the fracture and determine
the nature of the break. A ventro-dorsal radiograph was
required, and it was vital that the bird lay symmetrically
with the sternum super-imposed over the spine. If the body
was rotated it was not possible to compare both sides of the
pectoral girdle for asymmetry. The coracoids generally frac-
tured midshaft and the radiograph also allowed visualisation
of fragment displacement and overriding.
Surgical repair of the coracoid has been described.2 In this
study, anaesthesia was mask induced in each surgical candi-
date using isoflurane (Forthane, Abbott Australasia,
Kurnell, NSW) and the bird was placed on a heating pad.
With the bird lying on its dorsum the pectoral region was
plucked of all feathers and the skin prepared routinely for
surgery. A skin incision was made along the clavicle and
proximal half of the sternum and continued through the
pectoral muscles, which were reflected. Care was required to
avoid the pectoral vessels and nerves.3 The fracture was then
visualised through the incision site. An intramedullary pin
was introduced into the distal fragment, exiting at the
shoulder. The pin was then directed into the proximal frag-
ment (Figure 1). As the proximal end of the coracoid is
attached to the sternum, care was required not to advance
the pin too far, as it would have entered the thoracic cavity.
If this inadvertantly occurs the pin should be withdrawn
slightly.
Figure 1. Anatomy of the avian thoracic girdle showing
intramedullary pin placement to repair a fractured coracoid.
469
Clinical

Pectoral muscles and skin were sutured routinely. The end cated by the results of this study, a better return to function.
of the pin was cut off at the shoulder and the skin closed. Of the conservatively treated birds three were under the
Each bird was treated for 5 days postoperatively with 125 proposed 300 gram cut off. The galah and lorikeet were not
mg/kg amoxycillin/clavulanic acid intramuscularly once able to fly well enough for release, while the hobby escaped.
daily. No bandaging was used and each bird received cage The other birds all weighed above 300 grams, the black
rest for a minimum of 3 weeks, at which point a follow up falcon, weighing 948 grams, being the only bird flying well
radiograph was taken. The large pectoral muscle mass that enough to be released.
overlies the coracoid immobilised the fracture site leading to Of the surgically treated birds four were under 300 grams.
rapid healing. Depending on callus formation the pin was These included the kookaburra that was euthanased, the
removed 3 to 4 weeks post surgery. Each bird then entered a hobby that died, plus one other hobby and the sparrow-
period of flight training and rehabilitation prior to release. hawk. Body weight alone may be less significant to a bird’s
Birds treated conservatively were not bandaged, but release prospects than aspect ratio and wing loading,
provided with cage rest only. They were radiographed 3
weeks post arrival and, depending on callus formation and
fracture stability, they were then test flown. If flight capabil-
ities were adequate they entered the phase of flight training.
Where possible, aspect ratio and wing loading were calcu-
lated for the birds in the study. Aspect ratio is a measure of
the wingspan divided by the wing width. Wing loading
(g/cm2) is calculated by dividing the bird’s weight in grams
by the wing area. Wing area (cm 2 ) is calculated by the
following equation:
Wing area = [Wing Chord (cm)/0.62]2 (Figure 2).4,5
1.93

Results
Results are presented in Tables 1 and 2. Of the birds
Figure 2. Avian wing showing measurement of wing chord
treated conservatively, three were euthanased due to an
inability to fly and three were maintained in captivity, as
they could not fly adequately for release.
The brown goshawk was presented with an Table 1. Outcome, aspect ratio and wing loading of birds with fractured coracoids treated
old fracture of the coracoid that was not conservatively.
amenable to surgical repair. It flew well in
Species Outcome Weight (Grams) Aspect ratio Wingloading
captivity but did not survive once released
to the wild. Both the Australian hobby and Galah Captivity 290 5.4 0.40
black falcon flew well. The hobby escaped Black Falcon Released 948 4.6 0.43
and the black falcon was released to the
Australian Hobby Captivity 267 5.3 0.34
wild.
Of the birds treated surgically, six were Australian Hobby Escaped 342 5.8 0.46
released. The kookaburra had suffered severe Peregrine Falcon Euthanasia 477 6.6 0.59
soft tissue trauma on admission. The pin Brown Falcon Euthanasia 608 4.5 0.33
migrated out of the coracoid post surgery
Wedge-tailed Eagle Euthanasia 2780 6.8 0.55
and severe muscle necrosis developed, neces-
sitating euthanasia. The Australian hobby Brown Goshawk Died 356 - 0.38
was flying well and due for release when it Rainbow Lorikeet Captivity 133 6.1 0.45
succumbed unexpectedly to a presumptive
herpesvirus infection of the liver and spleen.
Table 2. Outcome, aspect ratio and wing loading of birds with fractured coracoids treated
surgically.
Discussion
Species Outcome Weight (Grams) Aspect ratio Wing loading
Coracoid fractures represent approxi-
mately 10% of the wild avian orthopaedic Kookaburra Released 332 4.4 0.47
cases presented to Healesville Sanctuary. Kookaburra Euthanasia 273 - 0.38
While the surgical technique has been Australian Hobby Died - Herpes 171 - 0.31
described, it has also been recommended
Australian Hobby Released 338 - 0.44
that birds under 300 grams in weight do not
require surgery but recover well with the Australian Hobby Released 203 - 0.29
wing bound to the body. 2 Prolonged Brown Goshawk Released 535 - 0.41
bandaging is often associated with patagial Brown Goshawk Released 506 - 0.39
contraction and elbow stiffness6 and should
Collared Released 216 3.6 0.24
be avoided wherever possible. Internal fixa-
Sparrowhawk
tion provides superior stability and, as indi-

470 Aust Vet J Vol 81, No 8, August 2003


although wing loading does vary directly with the bird’s
body weight.
The shape of a bird’s wing, in accordance with Bernoulli’s
principle, 7 forces air moving over the top of the wing to
travel faster than air flowing beneath it. The result is
decreased pressure above the wing, which generates lift
below the wing. The wider the wing the greater the pressure
differential and the more lift that is generated.
Consequently birds with long tapering wings, such as pere-
grine falcons, have a high wing loading (0.50 for males and
0.59 for females) and high aspect ratio (6.6). Those birds
with broader wings, such as black falcons, have a lower wing
loading (0.38 for males and 0.43 for females) and lower
aspect ratio (4.6). Therefore, a low wing loaded bird with a
broad wing would be more likely to obtain lift at a lower
speed, and fly successfully with an imperfectly healed cora-
coid, than a high wing loaded bird. This would explain why
a bird such as the black falcon, which is markedly above the
300 gram cut off (948 grams), was able to be released
without surgery. However, the smaller rainbow lorikeet (133
grams), which had a wing loading of 0.45 and an aspect
ratio of 6.1, and the galah (290 grams) with a wing loading
of 0.40 and an aspect ratio of 5.4, could not fly with conser-
vative treatment.
In light of this information it would seem prudent to
apply surgery to birds with high wing loadings and high
aspect ratios, such as peregrine falcons. The high wing
loading and aspect ratio means the bird has to attain a high
speed in order to become airborne. An imperfectly healed
coracoid will hinder the bird sufficiently to keep it
grounded. If conservative treatment is considered this
should be restricted to birds with low wing loadings and
aspect ratios. Quoting a bird’s weight as the cut off for
surgery may be misleading. Where possible surgery should
be the preferred option for birds destined to be returned to
the wild, as it not only improved the chances of a return to
Aust Vet J Vol 81, No 8 August 2003
Clinical
flight but resulted in a bird that flew sooner, thereby
reducing fitness loss and decreasing time spent in captivity.
For captive aviary birds, conservative treatment is likely to
be adequate, as return to full function is not essential.
A recent survey of the skeletons of 339 North American
accipiters found only one with a healed coracoid fracture.8
The authors speculated that this was because birds with
coracoid fractures are less likely to survive in the wild, a
finding supported by this study.
In conclusion, surgical repair of coracoid fractures should
be attempted where possible if it is intended to return the
bird to the wild. Success rate in the current study was high
and worth the investment in time and effort.
Acknowledgment
The author would like to thank Beth Croce for producing
the illustrations.
References
1. King AS, McLelland J. Skeletomuscular system. In: Birds: Their Structure
and Function. Bailliere Tindall, Eastbourne, UK, 1984:43-78.
2. Howard DJ, Redig PT. Orthopedics of the wing. Semin Avian Exotic Pet
Med 1994;2:51-62.
3. Orosz SE, Ensley PK, Haynes CJ. Surgical approaches to the thoracic
girdle and limb. In: Avian Surgical Anatomy: Thoracic and Pelvic Limbs.
Saunders, Philadelphia, 1992:41-57.
4. Cade TJ. Size and flying performance. In: The Falcons of the World.
William Collins Sons and Co, London, 1982:27-31.
5. Fox N. Structure and function. In: Understanding the Bird of Prey.
Hancock House Publishers, Surrey, Canada, 1995:16-57.
6. Redig PT. The use of an external skeletal fixator-intramedullary pin tie-in
(ESF-IM fixator) for treatment of longbone fractures in raptors. In: Lumeij
JT, Remple JD, Redig PT, Lierz M, Cooper JE, editors. Raptor Biomedicine
III. Zoological Education Network, Florida, USA, 2000:239-253.
7. Gill FB. Flight. In: Ornithology. 2nd edn. WH Freeman and Company,
New York, 1995:93-113.
8. Roth AJ, Jones GS, French TW. Incidence of naturally-healed fractures
in the pectoral bones of North American accipiters. J Raptor Res
2002;36:229-230.
(Accepted for publication 24 February 2003)
471