Use of Fine-threaded K-wires in the Treatment of Coronoid Fractures in Complex Elbow Instability

Abstract

The coronoid process is one of the main elbow constraints that provides ulnohumeral joint stability. Coronoid fractures may be fixed using multiple techniques, including transosseous sutures, screws, and plates. The goal of this study was to analyze the clinical and radiographic outcomes in a series of patients with complex elbow instability in whom coronoid fractures were repaired using fine-threaded K-wires. Eight men and 10 women (mean age, 47 years) were followed prospectively for a mean of 26 months. Surgical treatment consisted of open reduction and internal fixation of all fractures; radial head replacement in Mason III injuries; lateral collateral ligament repair in all patients; and, in cases of persistent instability, medial collateral ligament repair, hinged fixator application, or both. Coronoid fixation was performed using 2 or more fine-threaded K-wires, depending on the fragment size, inserted from the posterior aspect of the ulna and directed toward the coronoid fragment using a 1-step fixation technique. At last follow-up, mean extension was 15°, mean flexion was 133°, mean pronation was 78°, and mean supination was 69°; mean Disabilities of the Arm, Shoulder and Hand score was 9.7, mean American Shoulder and Elbow Surgeons score was 85, and mean Mayo Elbow Performance Score was 89. According to the Mayo Elbow Performance Index, 10 excellent, 7 good, and 1 fair result were recorded. All but 1 patient had a stable elbow. Fracture healing was observed in all but 1 patient. No secondary coronoid fragment dislocation or implant failures were reported. This study shows that using fine-threaded K-wires provides easy, minimally invasive, stable, and successful 1-step fixation that can be used to obtain osteosynthesis of coronoid fractures in patients with complex elbow instability.