Coronoid Fragment Research Articles

Three-dimensional quantitative study and functional outcome analysis of coronoid fracture in different elbow injury patterns

BackgroundCoronoid fractures are often part of a complex fracture-dislocation of the elbow. For an optimum prognosis, it is important to understand the characteristics of coronoid fractures in different elbow injury patterns. Significant differences in these characteristics have been observed in various studies, but these previous studies have suffered from limitations, such as insufficient quantification and unknown prognostic differences among different injury patterns. Therefore, we aimed to quantitatively analyze coronoid fracture characteristics and functional outcomes in different elbow injury patterns using 3D-CT. MethodsAll patients with coronoid fractures surgically treated at our hospital between January and December 2017 were categorized into three groups according to elbow injury pattern: PLRI, VPMRI and OFD. 3D models were reconstructed using Mimics 17.0, and the total volume (TV) and number of coronoid fragments (NCF) were measured. The coronoid process edge was classified into different anatomical regions, and each region was assigned a number to quantify the distribution of fracture lines. At the last follow-up, the ROM, VAS, MEPS, complications and reoperations were recorded. ResultsThe ninety-two patients enrolled had an average age of 42±15 years and a male-to-female ratio of 66:26. The median TV in PLRI patients was less than that in VPMRI patients [431 (132, 818)mm3 vs. 1125 (746,1421)mm3,adjusted P<0.001] and OFD patients [431 (132, 818) mm3 vs. 2565 (381, 4076)mm3, adjusted P =0.001]. The median NCF in PLRI patients was also less than that in VPMRI patients [1 (1, 2) vs. 2 (1, 3), adjusted P=0.043]. Most of the PCFL-Rs (79%) were located around the volar edge of the lesser sigmoid notch. Compared with that of PLRI, the PCFL-Us of the VPMRI and OFD tended to be located on the more ulnodorsal side of the coronoid process edge. The median ROM [110 (90, 133), P=0.001] and the median MEPS [85 (68, 95), P=0.038] of patients with OFD were significantly less than those of patients with the other two patterns. The incidence of elbow stiffness (56%, 5/9, P=0.001) and implant-related irritation (44%, 4/9, P<0.001) in the OFD group was significantly higher than that in the other two groups. ConclusionCoronoid fractures differ significantly in fragment volume, comminution severity and fracture line distribution among different elbow injury patterns. OFD has the worst functional outcomes among complex elbow injury patterns.

Pure varus posteromedial rotatory instability of the elbow: Radiographic findings, treatment, and outcomes

IntroductionAlthough varus posteromedial rotatory instability (VPMRI) is a subtle elbow injury that involves anteromedial coronoid facet (AMCF) fracture and ligamentous injuries, treatment options and outcomes of VPMRI remains controversial. The aim of this study was to investigate radiographic findings, treatments, and outcomes of a large series of VPMRI. MethodsWe retrospectively reviewed 91 pure VPMRI cases with AMCF fracture (O'Driscoll classification anteromedial type) which were treated at 6 hospitals. Clinical and radiographic outcomes were investigated with a mean follow-up period of 46.8 months using the Mayo elbow performance score (MEPS), and the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score, and serial plain radiographs. ResultsIn AMCF fracture, there were 4 cases of subtype 1, 67 cases of subtype 2, and 20 cases of subtype 3. On MRI, complete tears of lateral collateral ligament and medial collateral ligament were observed in 83.1 % (59/71 cases) and 33.8 % (24/71 cases). Operative treatment was performed in 68 cases (74.7 %) including both side fixation in 40 cases (58.8 %), medial side fixation only in 17 cases (25.0 %), and lateral side fixation only in 11 cases (16.2 %). Nonoperative treatment was performed in 23 cases (25.3 %). The mean final MEPS and Quick-DASH scores were 93.7 and 7.9. The overall complication and reoperation rates were 22.0 % and 15.4 %. No significant differences regarding final clinical scores and range of motions were observed between the operative group and the nonoperative group, but significant differences were observed regarding number (p = 0.019) and displacement (p = 0.002) of coronoid fragment, and complication rate (p < 0.001) between the two groups. ConclusionDepending on the pattern of coronoid fragment and the degree of ligamentous injuries, operative treatment of unstable VPMRI using various fixation techniques including coronoid fixation and ligament repair yielded satisfactory final clinical outcomes. However, surgeons should be aware of the high complication and reoperation rates after operative treatment. Stable VPMRI with AMCF fracture involving minimal displacement or small number of fragments can be treated nonoperatively.

Coronoid Fragment Size in Monteggia Fractures Predicts Ultimate Function.

We sought to determine what effect the size of a displaced coronoid fracture fragment in Monteggia injuries has on clinical outcome. Sixty-seven patients presented to an academic medical center for operative fixation of a Monteggia fracture. Radiographs were assessed for length and height of the displaced coronoid fragment using measuring tools in our center's imaging archive system. Data were analyzed using binary logistic or linear regression, as appropriate, controlling for sex, age, and Charlson Comorbidity Index. Outcome measurements included radiographic healing, range of motion, postoperative complications, and reoperation. The cohort had a mean follow-up of 16.7 months. Mean coronoid fragment area was 362.4±155.9 mm2. Elbow range of motion decreased by 3.8° of elbow flexion (P<.001), 3.3° of elbow extension (P<.001), and 3.8° of forearm supination (P=.007) for every 1-cm2 increase in coronoid fragment area. Complications (P=.012) and reoperation (P=.036) were associated with increasing coronoid fragment area. Nonunion rate, nerve injury, and pronation range of motion were not correlated to increasing coronoid fracture fragment area (P=.777, P=.123, and P=.351, respectively). As displaced coronoid fragment size increases in Monteggia fracture patterns, elbow range of motion decreases linearly. Coronoid displacement was also associated with increased rates of postoperative complication and need for reoperation. [Orthopedics. 2024;47(1):15-21.].

The ipsilateral olecranon tip is a suitable anatomic autograft for unrepairable coronoid fractures: A comparative three-dimensional mapping analysis.

Perform computed tomography (CT) three-dimensional (3D) mapping analysis of the ipsilateral olecranon tip to determine its suitability as an autograft for unrepairable coronoid fractures. CT was evaluated using Mimics 13.0 and 3-matic software (Materialise, Inc., Leuven, Belgium). Coronoid fracture fragment was measured from the medial sublime tubercle to the halfway point of the proximal radioulnar joint. Ipsilateral olecranon tip graft was measured at the equivalent height of the coronoid fragment and the angle of graft "cut" necessary to match the coronoid fragment was measured. The overall width of each graft site was measured in thirds and the congruity of surface geometry was measured by overlapping both fragments. The ipsilateral olecranon tip lateral facet which rotates to become the coronoid medial facet was also measured. The olecranon tip and coronoid fragments were similar in average maximum height and width. The average angle of graft cut needed to match the coronoid fragment was 86°. The average difference between the medial facet of the coronoid and lateral facet of the olecranon was <2 mm. The ipsilateral olecranon tip can be harvested through the same surgical incision and function as a local autograft during reconstruction of unrepairable coronoid fractures.

Functional Outcome of Surgically Treated Isolated Coronoid Fractures With Elbow Dislocation in Young and Active Patients.

Coronoid fractures are less frequent injuries seen in around one-tenth of patients with elbow dislocation. Any injury to the coronoid process can be associated with elbow instability, in which injury to collateral ligaments co-exists, resulting in a loss of congruency of the elbow joint. However, there is a scarcity of evidence regarding patients' management with elbow dislocation and associated coronoid fractures. So, our aim is to assess the functional outcome of the elbow after operative fixation in patients with any type of coronoid fracture with associated elbow dislocation. A total of six patients with closed coronoid fracture of the elbow, with associated elbow dislocation, without any other associated trauma or previous surgery to the same limb, were included in our study. After closed reduction, patients with an incongruent reduction of the elbow joint were operated. The injured structures were repaired in an inside-out sequence: the coronoid fragment was first reduced by using a lasso-type suture. The larger fragments of the coronoid were fixed with either a screw or a plate when deemed necessary. Then, the lateral collateral ligament was repaired either using a suture anchor or transosseous (No. 2 Arthrex; Naples, Florida) sutures.After repair, the elbow was examined for stability radiologically using the hanging arm test; a concentric reduction of the elbow in lateral view during this test indicates a stable elbow. All patients showed a good to excellent outcome on the Mayo elbow performance score (MEPS) at the final follow-up (three patients had an excellent score while three had a good score). At the final follow-up, mean elbow flexion was 124º, loss of extension was 10º in only one patient, mean supination was 80º, and mean pronation was 72º. Isolated fractures of the coronoid associated with elbow dislocation require appropriate evaluation and management. Closed reduction and immobilization alone in young and active patients may not be sufficient, especially in patients with incongruent ulnohumeral joint. Surgical fixation of the coronoid fragment and repair of the collateral ligament, whenever indicated, can provide good functional outcomes.

Complex Monteggia Fractures in the Adult Cohort: Injury and Management.

Monteggia fractures involve proximal ulna fracture associated with a radiocapitellar joint dislocation. The Bado classification is primarily based on the direction of the radial head dislocation. The Jupiter subtype classification of Bado II fractures further characterizes the severity of proximal ulna comminution and the involvement of the coronoid fragment. This latter classification can better prognosticate the challenges of surgical reconstruction and clinical outcomes. Surgery for all adult Monteggia fractures is required to restore the anatomic alignment of the ulna, which indirectly reduces the radiocapitellar joint. The complexity of the injury is considerably increased by comminution of the proximal ulna, the degree of radial head fragmentation, the reduction of the radial head, and ulnohumeral instability. Anatomic reduction is considered critical to achieving a favorable outcome.

Fractures of the proximal ulna: current concepts in surgical management.

Fractures of the proximal ulna range from simple olecranon fractures to complex Monteggia fractures or Monteggia-like lesions involving damage to stabilizing key structures of the elbow (i.e. coronoid process, radial head, collateral ligament complex).In complex fracture patterns a computerized tomography scan is essential to properly assess the injury severity.Exact preoperative planning for the surgical approach is vital to adequately address all fracture parts (base coronoid fragments first).The management of olecranon fractures primarily comprises tension-band wiring in simple fractures as a valid treatment option, but modern plate techniques, especially in comminuted or osteoporotic fracture types, can reduce implant failure and potential implant-related soft tissue irritation.For Monteggia injuries, the accurate anatomical restoration of ulnar alignment and dimensions is crucial to adjust the radiocapitellar joint.Caution is advised if the anteromedial facet (anatomical insertion of the medial collateral ligament) of the coronoid process is affected, to avoid posteromedial instability.Radial head reconstruction or replacement is essential in Monteggia-like lesions to restore normal elbow function.The postoperative rehabilitation programme should involve active elbow motion exercises without limitations as early as possible following surgery to avoid joint stiffness.Cite this article: EFORT Open Rev 2019;4:1-9. DOI: 10.1302/2058-5241.4.180022.

Classifications in Brief: Regan-Morrey Classification of Coronoid Fractures.

Classifications in Brief: Regan-Morrey Classification of Coronoid Fractures.

Complex Elbow Dislocations and the "Terrible Triad" Injury.

Background:The elbow is the second most commonly dislocated joint in adults and up to 20% of dislocations are associated with a fracture. These injuries can be categorised into groups according to their mechanism and the structures injured.Methods:This review includes a literature search of the current evidence and personal experiences of the authors in managing these injuries.Results:All injuries are initially managed with closed reduction of the ulno-humeral joint and splinting before clinical examination and radiological evaluation. Dislocations with radial head fractures should be treated by restoring stability, with treatment choice depending on the type and size of radial head fracture. Terrible triad injuries necessitate operative treatment in almost all cases. Traditionally the LCL, MCL, coronoid and radial head were reconstructed, but there is recent evidence to support repairing of the coronoid and MCL only if the elbow is unstable after reconstruction of lateral structures. Surgical treatment of terrible triad injuries carries a high risk of complications with an average reoperation rate of 22%. Varus posteromedial rotational instability fracture-dislocations have only recently been described as having the potential to cause severe long-term problems. Cadaveric studies have reinforced the need to obtain post-reduction CT scans as the size of the coronoid fragment influences the long-term stability of the elbow. Anterior dislocation with olecranon fracture has the same treatment aims as other complex dislocations with the added need to restore the extensor mechanism.Conclusion:Complex elbow dislocations are injuries with significant risk of long-term disability. There are several case-series in the literature but few studies with sufficient patient numbers to provide evidence over level IV.

Complex elbow instability: surgical management of elbow fracture dislocations.

There are three main patterns of complex elbow instability: posterolateral (terrible triad), varus posteromedial (anteromedial coronoid fracture with lateral collateral ligament complex disruption), and trans-olecranon fracture dislocations.Radial head fractures, in the setting of complex elbow instability, often require internal fixation or arthroplasty; the outcome of radial head replacement is dictated by adequate selection of the head diameter, correct restoration of radial length, and proper alignment and tracking.Small coronoid fractures can be ignored. Larger coronoid fractures, especially those involving the anteromedial facet, require fixation or graft reconstruction, particularly in the presence of incongruity.The lateral collateral ligament complex should be repaired whenever disrupted. Medial collateral ligament disruptions seem to heal reliably without surgical repair provided all other involved structures are addressed.The most common mistakes in the management of trans-olecranon fracture dislocations are suboptimal fixation, lack of fixation of coronoid fragments, and lack of restoration of the natural dorsal angulation of the ulna.Cite this article: Sanchez-Sotelo J, Morrey M. Complex elbow instability. EFORT Open Rev 2016;1:183-190.

Functional outcomes after fixation of "terrible triad" elbow fracture dislocations.

Historically, the published literature on "terrible triad" injuries has shown a high rate of unacceptable results. The use of systematic treatment protocols may improve functional outcome. The authors performed a retrospective study of all patients aged 18 years or older who underwent surgical treatment for "terrible triad" elbow fracture dislocation at their institution over a period 7 years. Surgical treatment involved fixation or replacement of the radial head, repair of the anterior capsule or coronoid fracture in most cases, and repair of the lateral collateral ligament. Outcomes included grip strength, range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score, and a visual analog score for pain as well as radiographic assessment of arthritis, maintenance of reduction, and development of heterotopic ossification. Eighteen patients were identified and 11 enrolled. Seven patients had suture fixation of the coronoid fragment and anterior capsule, 2 had screw fixation, and 2 had no repair of the coronoid. The radial head was replaced in 9 patients and repaired in 1, and a fracture fragment was excised in another. The average follow-up was 38 months. The average arc of motion of the injured elbow was 112° and that of the contralateral elbow was 142°. The average DASH score was 19.7 (scale, 0-100). The average visual analog score for pain was 2.2 (scale, 0-10). No patients had recurrent elbow instability. Three patients underwent further surgical procedures, all for loss of motion. The authors concluded that a systematic approach to the fixation of "terrible triad" elbow fracture dislocations can provide predictable elbow stability and functional range of motion in the medium term.

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

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.

Comment on the anterior approach for coronoid process fracture

We are very interested in the article by Han et al. [1] entitled ‘‘anterior approach for fixation of isolated type III coronoid process fracture’’. It’s well known that the coronoid process is the anterior portion of the proximal articular surface of the ulna and the important bone structure providing ulnohumeral joint anterior stability. There are two osseous eminences in the coronoid process, the tip and the sublime tubercle. Some important soft tissue structures insert on the coronoid process: the anterior articular capsule, the tendon of the brachialis muscle, and the anterior band of the medial collateral ligament (AMCL). The structures maintain the anterior stability of elbow together. The study of coronoid process fracture has been the central issue of elbow trauma and instability in recently years. The fractures of coronoid process are commonly associated with complex elbow fracture-dislocation, and isolated coronoid process fractures are uncommon. There is some controversy about fixation means of the coronoid process fragment. As described in the article that many published papers with treatment of coronoid fractures, but little has been published about the surgical approach related to operative fixation. The most common approach for fixation of coronoid process fractures has been described from medial and posterior. The anterior approach is seldom used, and rare relevant literatures about anterior approach for coronoid process fractures were reported. Because the brachial artery and its branches, median nerve, which lie in the anterior of the elbow. There is great risk of iatrogenic injury to the neurovascular structures. The medial approach is the most commonly used in our institution. But we found that it is usually hard to exposure the fragments of the coronoid process from the medial incision clearly, because of the very thick flexor-pronator mass. We had performed some dissection research about the anterior approach to expose the coronoid process. In the course of our study, we found that there are some branches from the proximal radial artery and ulna artery, which constitute the vascular tree in the superficial structure of the brachialis insertion. Especially, the radial recurrent artery traverses the brachialis muscle surface. The distance of the brachial artery retracted medially is restricted by the anatomical characteristics. There are some difficulties to reduce and fix the coronoid fragment with a buttress plate in this area, but the cannulated screw is convenient to be used. We admired the authors’ skilled technique and courage. So we also want to consult some detail technique about the exposure of the coronoid process during the operation. How to optimally handle the artery branches to harvest more operating space? Whether the radial recurrent artery must be cut? The anterior approach can not be used to repair the associated ligament injury (lateral collateral ligament or medial collateral ligament). In the article, the author described that the cases were all isolated coronoid process fracture without associated ligament injury resulting in joint instability. The study was retrospective, so the incision position must be determined preoperatively. In other words, the patients with coronoid process fracture and elbow dislocation, without ligament injury, should be made a definite diagnosis before operation. How to ensure that the patients were not associated ligament injury resulting in instability of ulnohumeral joint? What accessory examination should be performed? We think that it is not accurate to diagnose the ligament without injury only through X. Zhu X. Wang (&) Z. Ma Department Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China e-mail: wangxin1681@126.com

Medial compartment disease bij een jonge grote münsterländer

Medial Compartment Disease (MCD) is een recentelijk herkende aandoening van de elleboog bij de hond en verwijst naar uitgebreide kraakbeenerosie in het mediaal gedeelte van het ellebooggewricht. Deze casuïstiek beschrijft een geval van MCD bij een grote münsterländer van tien maanden oud, aangeboden met de klacht van manken op de rechtervoorpoot. Op basis van het signalement, de anamnese en het radiografisch onderzoek was er een sterk vermoeden van een losse processus coronoïdeus van de rechterelleboog. Artroscopische inspectie van het gewricht bracht naast een klein coronoïdfragment en een klein osteochondrotisch letsel echter ook uitgebreide kraakbeenerosie van de mediale humeruscondyl en de mediale processus coronoïdeus aan het licht. Na de artroscopische behandeling vertoonde de hond geen beterschap. Een behandeling met autoloog geconditioneerd plasma (Arthrex- ACP®) gaf evenmin substantiële verbetering. Uiteindelijk werd de hond geëuthanaseerd omwille van aanhoudend manken.

Partial allograft replacement of the radial head in the management of complex fracture-dislocations of the elbow

There have been reports of total radial head allografts showing variable outcomes. This case series reports the novel use of an allograft for partial radial head replacement in the treatment of elbow fracture-dislocation. Eight patients underwent partial radial head allograft reconstruction to restore stability for complex fracture-dislocations involving fractures of the coronoid and radial head, with collateral ligament disruption. Two patients were treated acutely. Six were referred from other centers 2 to 48 weeks after injury following failure of primary treatment. In each case, it was not possible to perform stable open reduction-internal reduction of the radial head fracture, or the fracture fragment had already been excised. A fresh-frozen partial radial head allograft was used to replace the defect and restore the joint surface. The coronoid fracture and injury to collateral ligaments were also managed surgically. Patient charts, surgical records, and radiographs were reviewed. Patients were contacted at a mean of 79 months after treatment to answer questions to determine the Mayo Elbow Performance Score and the score on the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Clinical and radiologic reviews confirmed union of graft in all cases. None resorbed or collapsed. Three patients had resorption of the coronoid fragment resulting in poor outcomes, with one patient ultimately undergoing total elbow arthroplasty. Partial radial head allograft may be a useful alternative to radial head prosthesis in unstable fracture-dislocations in which the radial head cannot be restored fully.

Conservative Versus Arthroscopic Management for Medial Coronoid Process Disease in Dogs: A Prospective Gait Evaluation

To investigate, using objective gait analysis, the long-term outcome of dogs with medial coronoid process disease (MCPD) treated with conservative management (CM) versus arthroscopic treatment (AT). Prospective clinical trial. Dogs (n = 20) with unilaterally confirmed MCPD. Eleven dogs were treated arthroscopically with removal of coronoid fragments and burring of any associated chondromalacic cartridge and 9 dogs were managed conservatively. All dogs were administered a 6-week course of oral tepoxalin on enrollment. Inverse dynamics gait analysis was performed at initial presentation and at 4, 8, 26, and 52 weeks. The gait variables analyzed were elbow moment (EM), elbow power (EP), total support moment (TSM), and total support moment ratio (TSMR) as a measure of forelimb asymmetry. Affected peak EM increased from 0.58 to 0.76 Nm/kg in the AT dogs, and from 0.66 to 0.81 Nm/kg in the CM dogs and there was no significant difference between groups. Affected peak EP increased marginally in the AT dogs, but was unchanged in the CM dogs and there was no significant difference between groups. TSM increased from 1.49 to 1.92 Nm/kg in the AT dogs and from 1.52 to 2.06 Nm/kg in the CM dogs and there was no significant difference between groups. TSMR was statistically different between treatment groups at 1 (P = .003) and 2 months (P = .048) with the AT group more asymmetric and hence more lame. TSMR at 12 months was 0.83 (AT) and 0.86 (CM) implying a failure of return to soundness by either group. AT dogs had increased mechanical asymmetry at 4 and 8 weeks compared to the CM group revealing surgery worsened limb function. There was no significant difference in mechanical symmetry between groups at 26 and 52 weeks.

Medial Complex Elbow Dislocation: An Unusual Pattern of Injury

A 47-year-old man sustained a medial complex dislocation of the right elbow. After initial evaluation, closed reduction was performed. On examination under general anesthesia, the elbow was unstable under varus and valgus stress. Computed tomography scan showed a medial epicondyle and a coronoid fracture. Both medial and lateral approaches were used to fix the epicondylar fragment, the coronoid fragment, and the complex damage to the soft tissues. Immobilization in a cast for 1 week followed by early motion in a dynamic orthosis resulted in a good outcome. Follow up at 2 years showed a range of motion of 110 degrees of flexion-extension and 170 degrees of pronation-supination. Radiographs showed no significant arthritis or heterotopic ossifications.

A minimally invasive anterior approach to reduction and screw fixation of coronoid fractures

We investigated a minimally invasive anterior approach to reduce and fix coronoid fractures with a screw in eight consecutive patients and evaluated seven patients at a minimum of 1 year (mean, 78 weeks; range, 61-89 weeks). It was only possible to repair seven of eight coronoid fractures. The average time to radiographic healing was 12 weeks and all healed without the screw loosening, migration or breakage. Endoscopy permitted an excellent view of coronoid fractures, allowing anatomic fixation, and as it avoided extensive soft tissue dissection, this method preserved soft tissue attachments of small coronoid fragments. This method was safe and minimally invasive.

Arthroscopically Assisted Coronoid Fracture Fixation: A Preliminary Report

We investigated the feasibility of arthroscopically assisted reduction and fixation of small coronoid fractures and the anterior capsule for treatment of patients with Regan and Morrey Types I and II (O'Driscoll Types I and II) coronoid fractures with instability of the ulnohumeral joint. Four consecutive patients with this fracture type underwent arthroscopically assisted treatment and were evaluated at a minimum of 1 year (mean, 76 weeks; range, 58-92 weeks). All patients achieved a functional range of motion with an average flexion/extension arc of 2.5 degrees to 140 degrees and full pronation and supination. No patient had recurrent elbow instability. One patient had removal of a prominent suture over the subcutaneous border of the ulna. Arthroscopically assisted management of coronoid fractures can provide excellent observation, enabling anatomic repair without extensive soft tissue dissection. Preservation of the soft tissue attachments of small coronoid fragments and repair of the capsule are possible with this technique. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Fractures of the Coronoid Process of the Ulna: Which Ones to Fix and Which Ones to Leave Alone: A Review

The coronoid process of the ulna forms the anterior boundary of the trochlear notch and is crucial for elbow stability. Coronoid fractures are uncommon and they occur in aproximately 10% of elbow dislocations. They are mostly associated with ligamentous and capsular disruptions as well as concomitant fractures. Posterior elbow dislocations, combined with fractures of the coronoid and the radial head are known as the terrible-triad of the elbow. These injuries result in instability of the elbowjoint and, if not treated properly, lead to recurrent dislocations that can cause further damage. Depending on the pattern of the injury and the quality of the bone, the surgeon has to choose from a variety of treatment options. Large coronoid fragments and other associated fractures are ideally treated by ORIF (open reduction internal fixation); a prosthetic radial head replacement may be favorable if a comminuted radial head fracture is not reconstructable. Isolated small coronoid process fractures can be treated non-operatively with satisfactory results. Although rough guidelines can bemade, it is important to view each patient's elbow injury individually and then make a specific treatment plan. Data on treatment results are sparse. Improved understanding of coronoid fractures and their management will result in better outcomes and decrease possible complications including a certain degree of stiffness, neuropathy and arthrosis.