A comparative study on the validity and reliability of anterior, medial, and posterior approaches for internal fixation in the repair of fractures of the coronoid process of the ulna

Hong-Wei Chen,Xiao-Feng Teng

doi:10.1186/s40001-018-0336-7

Hong-Wei Chen, Xiao-Feng Teng

Open Access

https://doi.org/10.1186/s40001-018-0336-7

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Abstract

BackgroundThe coracoid process plays an important role in maintaining the stability of the elbow joint. A fracture of the coronoid process is often treated via surgical approaches, including open reduction and internal fixation, which aim to regain a stable, flexible, and loadable joint. In this study, we compared the anterior, medial, and posterior approaches of internal fixation in the repair of fractures of the coronoid process of the ulna.MethodsIn this retrospective study, 147 patients with fractures in the coronoid process of the ulna were recruited and classified into the anterior group (n = 73), the medial group (n = 32), and the posterior group (n = 42) according to the surgical approach used for internal fixation. These patients were assessed with respect to incision, operative time, estimated blood loss, fracture healing, and postoperative complications. The Mayo Elbow Performance Score was used to evaluate any form of disability associated with elbow injuries. Multivariate logistic regression analysis was performed to investigate the factors influencing the efficacy of fractures of the coronoid process of the ulna.ResultsIn the medial approach group, the operative time was longer, and perioperative blood loss and postoperative drainage volume were obviously increased compared with the anterior and posterior groups. The anterior group exhibited a better postoperative recovery compared with the medial, and posterior groups. Compared with the anterior group, fracture-healing time in the posterior group was further reduced, whereas elbow joint flexion extension and forearm rotation degree improved. Complications were significantly reduced in the posterior approach group compared with the anterior and medial groups. The factors influencing the efficacy of fractures of the coronoid process of the ulna included the Regan–Morrey classification, perioperative blood loss, and the internal fixation approach.ConclusionIn summary, the approach used influences fracture healing or the outcome after osteosynthesis. The posterior internal fixation method produced satisfactory functional outcomes in patients with fractures of the coronoid process of the ulna.

Highlights

The coracoid process plays an important role in maintaining the stability of the elbow joint
The results revealed no significant differences in mean age, gender, Regan–Morrey classification, injury site, cause of injury, fractures of the coronoid process of the ulna combined with elbow joint dislocation, and the time from injury to surgery among the three groups (Table 1)
The key findings from the present study demonstrated that the therapeutic efficacy of fractures of the coronoid process of the ulna treated using the posterior approach of internal fixation is improved compared with the anterior approach and medial approach

Summary

Introduction

The coracoid process plays an important role in maintaining the stability of the elbow joint. We compared the anterior, medial, and posterior approaches of internal fixation in the repair of fractures of the coronoid process of the ulna. The elbow joint is the second-most common joint in the body that is prone to dislocation in adults. This type of dislocation is classified as simple or complex. The coronoid process is important for the stability of the elbow joint [3] Given that this condition is often misdiagnosed or ignored due to the complicated pathogenesis, a fracture of the coronoid process of the ulna is a major problem in elbow joint trauma and instability [4]. Regan–Morrey distinguished three types of coronoid process fractures: type I fracture (the avulsion fracture of the ulna coronal apex), type II fracture (the fracture block does not involve greater than 50% of the entire coronoid process), and type III fracture (the fracture block exceeds 50%) based on the involvement of the coronoid process [5,6,7]

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