Non-operatively Treated Fractures of the Anteromedial Facet of the Coronoid Process: A Report of Six Cases

Abstract

The non-operative treatment of six patients with fracture of the anteromedial facet of the coronoid process is described. We identified and reviewed the medical records of six patients with a non-operatively treated O'Driscoll type II anteromedial facet fracture of the coronoid. Clinical outcome was evaluated using the Broberg and Morrey rating system. Three patients who returned for a medium long-term research specific follow-up were also evaluated with the American Shoulder and Elbow Surgeons (ASES) Self-Report Form, the Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Measure and the Mayo Elbow Performance Index (MEPI). All three patients who returned for follow-up regained full or near full elbow flexion and full or near full forearm rotation. Two patients had a MEPI score of 100 points, and one patient scored 40 points. According to the MEPI classification system, there were two excellent results (66.6%) and one poor result (33.3%). According to the Broberg and Morrey system, all patients had an excellent result. Two patients scored 100 points on the ASES score, and one patient scored 56 points. The DASH scores were 0 points, 2.5 points and 49.1 points, respectively. Anteromedial facet fractures can be very subtle injuries, and we recommend their careful evaluation and management. Non-operative treatment can be considered if subluxation is excluded and the fracture is small and minimally displaced. The nature of the injury can be most reliably documented using computed tomography with three-dimensional reconstructions.