Progress in treatment of elbow fracture-dislocation combined with coronary fractures

Abstract

Elbow fracture-dislocations are typically high-energy injury. Fractures of the coronoid process are usually part of this injury. Successful management of elbow fracture-dislocations associated with coronoid fracture requires recognition of the injury pattern and early treatment to obtain adequate elbow stability. Although some special cases of terrible triad of the elbow can be managed non-operatively, the majority of the frac-ture-dislocations are repaired by surgery. Tip fractures are usually repaired with a lasso suture, steel wire tension band or loop plating along with repair or replacement of the radial head and the lateral collateral ligament. Fractures of the anteromedial coronoid are theorized to occur from varus posteromedial rotatory injury. A subset of the injury can be managed non-operatively. Internal fixation with a buttress plate and reattachment of the lateral collateral ligament is recommended for injuries associated with large fracture fragments or elbow instability. Transolecranon fracture-dislocations are best treated surgically with stable restoration of the trochlear notch. If the elbow is still unstable, it is required to repair the medial collateral ligament or to apply hinged external fixators to maintain concentric reduction and initiate early exercises. Key words: Elbow joint; Dislocations; Fractures, bone; Surgical procedures, operative