Quantitative 3-Dimensional Computed Tomography Measurements of Coronoid Fractures

Abstract

Using quantitative 3-dimensional computed tomography (Q3DCT) modeling, we tested the null hypothesis that there was no difference in fracture fragment volume, articular surface involvement, and number of fracture fragments between coronoid fracture types and patterns of traumatic elbow instability. We studied 82 patients with a computed tomography scan of a coronoid fracture using Q3DCT modeling. Fracture fragments were identified and fragment volume and articular surface involvement were measured within fracture types and injury patterns. Kruskal-Wallis test was used to evaluate the Q3DCT data of the coronoid fractures. Fractures of the coronoid tip (n= 45) were less fragmented and had the smallest fragment volume and articular surface area involvement compared with anteromedial facet fractures (n= 20) and base fractures (n= 17). Anteromedial facet and base fractures were more fragmented than tip fractures, and base fractures had the largest fragment volume and articular surface area involvement compared with tip and anteromedial facet fractures. We found similar differences between fracture types described by Regan and Morrey. Furthermore, fractures associated with terrible triad fracture dislocation (n= 42) had the smallest fragment volume, and fractures associated with olecranon fracture dislocations (n= 17) had the largest fragment volume and articular surface area involvement compared with the other injury patterns. Analyzing fractures of the coronoid using Q3DCT modeling demonstrated that fracture fragment characteristics differ significantly between fracture types and injury patterns. Detailed knowledge of fracture characteristics and their association with specific patterns of traumatic elbow instability may assist decision making and preoperative planning. Quantitative 3DCT modeling can provide a more detailed understanding of fracture morphology, which might guide decision making and implant development.