Comparative study on effect of coronoid fixation with lateral collateral ligament repair versus hinged external fixator in treatment of elbow varus posteromedial rotational instability

Abstract

Objective To compare the effect of coronoid fixation combined with lateral collateral ligament repair versus hinged external fixator in treatment of elbow varus posteromedial rotational instability. Methods This retrospective cohort research included 34 patients with elbow varus posteromedial rotational instability operated between January 2011 and June 2015. All patients had coronoid process fractures of O' Driscoll type Ⅱ (six with subtype 1, 24 with subtype 2 and four with subtype 3). Fifteen of the 34 patients were operated by coronoid fixation combined with lateral collateral ligament repair (Group A) and other 19 patients were operated by coronoid fixation combined with placing hinged external fixator (Group B). Interval between injury and operation, operation time and blood loss were recorded. At final follow-up, elbow range of motion, Mayo elbow performance score (MEPS) and Hastings and Graham heterotopic ossification classification were measured. Results There were no significant differences in the interval between injury and operation, operation time and blood loss between the two groups (P>0.05). Median period of follow-up was 30 months in Group A and 40 months in Group B. Last follow-up showed flexion of the affected elbow in Group B [145° (135°-150°)] was better than that in Group A [140° (130°-145°)] (P 0.05). MEPS in Group A scored 100 in 10 patients, 90 in three, 85 in one and 70 in one; MEPS in Group B scored 100 in 13 patients, 90 in one, 85 in four and 80 in one. There was no significant difference in MEPS between the two groups (P>0.05). Conclusion For treating elbow varus posteromedial rotational instability, either lateral collateral ligament repair or hinged external fixation after anatomic reduction and coronoid fixation can achieve good results. Key words: Elbow joint; Intra-articular fractures; Coronoid process