Mid-term results of fixation of coronoid fractures via modified anterior elbow neurovascular interval approach

Abstract

Objective To explore the efficacy and complication prevention of operative fixation of coronoid fractures via neurovascular interval of anterior elbow approach. Methods From March 2006 to September 2009, data of 21 patients with coronoid process fractures associated with complex elbow dislocation who were treated via neurovascular interval of anterior elbow approach in my ward were retrospectively analyzed. There were 14 males and 7 females. The mean age of the patients was 31.6 years (range, 18-52 years). Injury was caused by walk falling in 10 cases, falling from standing-height in 3 cases and sports events in 8 cases; 7 patients were left side and 14 patients were right side, including 16 prominent sides and 5 non-prominent sides. There were 3 type Ia, 3 type IIa, 8 type IIb, 4 type IIc, 3 type IIIa coronoid process fractures according to the O'Driscoll's classification. Pre-operative 3D-CT scans were conducted to clarify if there were subluxations or sign of instabilities in elbows. Operative fixation of coronoid process fractures with cannulated screws and/or mini plates and/or suture anchors were carried out via the anterior interval between humeral vessels and median nerve, and then lateral collateral ligaments were repaired if instability still existed. Results The average operation time was 72 min, and the follow-up time was 52-74 months. Only 1 case of type Ia fracture got nonunion because of early postoperative activities from the first day after the operation and the elbow was fixed at 0 degree of extension with brace. At the latest follow-up, in suture anchor fixation group (3 cases), the average VAS was 1.8±0.5, Broberg-Morrey score 90.2±6.6, extension deficiency 11.2°±3.6°, flexion 133.4°±8.8°, and the excellent-good-rate was 66.7% (2 cases excellent and 1 fair). In the screw-fixation group (10 cases), the average VAS was 1.6±0.8, Broberg-Morrey score 89.2±6.6, extension deficiency 15.2°±4.6°, flexion 130.8°±10.8°, and the excellent-good-rate was 90% (6 cases excellent, 3 good, and 1 fair). In the mini plate fixation group (8 cases), the average VAS score was 1.6±0.7, Broberg-Morrey score 88.6±6.7, extension deficiency 11.8°±5.6°, flexion 134.2°±8.6°, and the excellent-good-rate was 87.5% (4 cases excellent, 3 good, and 1 fair). In the lateral ligament repaired group (14 cases), the average VAS was 1.3±0.9, Broberg-Morrey score 91.5±6.3, extension deficiency 10.2°±3.4°, flexion 135.2°±4.2°, and the excellent-good-rate was 100% (8 cases excellent, 6 good). In the lateral ligament non-repaired group (7 cases), the average VAS was 2.2±1.6, Broberg-Morrey score 80.2±13.8, extension deficiency 13.6°±4.4°, flexion 126.6°±4.0°, and the excellent-good-rate was 71.4% (3 cases excellent, 2 good, 1 fair). There were 5 cases which had early osteoarthritis changes in the elbow joint in 3 years’ follow-up, with the incidence rate 23.8% (5/21), and the incidence of mid-term osteoarthritis in the 5 and 7 years after operation was 4.8% (1/21). Conclusion Operative fixation of coronoid fractures with suture anchor and/or cannulated screw and/or mini plate via neurovascular interval of anterior elbow approach was confirmed to be efficient and safe. Lateral collateral ligaments should be repaired if the elbow is unstable. Key words: Elbow joint; Dislocations; Joint instability; Ulna fractures