Coronoid Process Fractures Research Articles

Progress on diagnosis and treatment of the terrible triad of elbow joint

The terrible triad of elbow is a kind of complex elbow fracture dislocation, after reduction, it should get a concentric circles joint reduction and elbow stability, if radial and coronoid process fractures is less piece, the conservative treatment can be performed, but regularly follow up is mandatory. If surgical treatment was chosen, radial head fractures and the lateral collateral ligament complex must be repaired. Single lateral approach can be used and also can be combined with anteromedial approach in surgery. Some problems are still controversial in the treatment of coronoid process fracture with Morry type I and type II, such as fixation or not, whether additional external fixation and repair of the medial collateral ligament injury at the same time.

Combined anterior and posterior approach in treatment of transolecranon fracture-dislocation

Objective To observe the treatment of transolecranon fracture-dislocation using combined anterior and posterior approach. Methods From September 2010 to October 2014, 6 patients(4 males and 2 females)with transolecranon fracture-dislocation were treated via the combined anterior and posterior approach at our department. Their average age was 42. 5 years(from 25 to 63 years). One case had open injury(Gustilo-Anderson type I)and 5 closed injury. Six cases were associated with coronoid process fracture and 5 with radial head fracture. Bone union was assessed by elbow anterioposterior and lateral radiographs. The elbow function was assessed at the last follow-up according to the Broberg-Morrey functional rating indexes. Results All the 6 patients achieved primary incision healing with no early complications. They were followed up for an average period of 14 months(from 9 to 22 months). All fractures healed 6 months post-operation. At the last follow-up, the average elbow flexion range was 127°(from 90° to 145°)and the average rotation range was 112°(from 80° to 150°). The mean Broberg and Morrey functional score was 89 points(from 74 to 96 points). Two cases were excellent, 3 good, and one moderate. No implant failure, heterotopic ossification or elbow instability was observed at the last follow-up. Conclusion In treatment of transolecranon fracture-dislocation, combined anterior and posterior approach provides clear vision which benefits anatomical reduction and stable fixation. Also it allows early mobilization of the elbow and leads to good short-term results. Key words: Ulnar fractures; Dislocations; Fracture fixation, internal

Traumatic fracture of the medial coronoid process in 24 dogs.

To describe traumatic fracture of the medial coronoid process in dogs as a clinically distinct disease unrelated to congenital elbow dysplasia. Clinical records of dogs with acute, traumatic, unilateral lameness attributable to medial coronoid process disease were reviewed retrospectively. Clinical interpretation included findings on physical examination, orthopaedic examination, and subjective gait analysis. Radiographs of the affected and contralateral elbows were obtained and reviewed for pathology. Arthroscopy of the elbow joints was performed by one of three surgeons and findings were compared to preoperative diagnostics. Postoperative follow-up was continued for 16 weeks. Twenty-four dogs were included in this study. All dogs in this study were free of radiographic evidence of medial coronoid pathology. All dogs were diagnosed with a single, large, displaced or non-displaced fracture of the medial coronoid process, with no other joint pathology. Dogs generally had an excellent short-term outcome following arthroscopic treatment of the fractured medial coronoid process. Traumatic fracture of the medial coronoid process should be considered a clinical disease distinct from dysplasia-related fragmentation and should be considered as a differential diagnosis in dogs that are presented with the complaint of acute unilateral elbow discomfort or lameness, especially after concussive activities involving the forelimb. .

Arthroscopic fixation of coronoid process fractures through coronoid tunnelling and capsular plication.

the purpose of this study is to describe a new arthroscopic technique for reduction and fixation of coronoid process fractures (CPFs) and report clinical and functional results in 4 patients after a 24-month follow-up. four patients underwent arthroscopic reduction and fixation of isolated CPFs (acute or non-unions, type I or type II according to the Regan-Morrey classification) performed using a new technique based on coronoid tunnelling and capsular plication. The patients were evaluated 6, 12 and 24 months after surgery, using the Disability of the Arm, Shoulder and Hand scale (DASH), the Mayo Elbow Performance Index (MEPI), and a visual analog scale (VAS); elbow range of motion (ROM) and joint stability were also evaluated and the rate of complications was reported. all 4 patients completed the follow-up. At 6, 12 and 24 months, respectively, they recorded mean DASH scores of 22, 14 and 7, mean MEPI scores of 74, 82 and 94, and mean VAS scores of 4, 2 and 1. The mean ROM increased in all directions (at 6, 12 and 24 months, respectively: flexion: 112°, 125°, 144°; extension: 3°, 5°, 6°; pronation: 76°, 84°, 91°; supination: 78°, 82°, 86°). No signs of instability were observed and no complications were reported. the new all-arthroscopic coronoid tunnelling and capsular plication technique here proposed can restore elbow function, ROM and stability and allows anatomical reconstruction of the joint after type I or type II CPFs. If performed by an experienced arthroscopist, it is a valid alternative to open reduction and external fixation. Level IV, retrospective case series.

ARTHROSCOPIC METHOD OF THE RADIAL HEAD FRACTURE OSTEOSYNTHESIS (СASE REPORT)

Radial head fractures constitute about 3% of all fractures and 30% within the group of elbow joint injuries. Conventional open surgical treatment is accompanied by an extensive soft tissue incision and sometimes by capsule release for adequate visualization. Arthroscopic methods feature relatively insignificant soft tissue trauma, allow to reduce pain syndrome in postoperative period and to accelerate rehabilitation. Besides, arthroscopy improves surgical view in cases of intraarticular fractures and facilitates a better anatomical reduction of articular surface. The authors demonstrate a clinical case of a patient with closed fractures of radial head and ulna coronoid process with displacement of left elbow joint fragments where arthroscopic surgery provided for good anatomical and functional results.

Mini-plate fixation of ulnar coronoid process fracture via anteromedial approach

Objective To investigate the clinical efficacy of mini-plate fixation for ulnar coronoid process fracture via anteromedial approach. Methods A retrospective review was made on 28 cases of ulnar coronoid process fracture treated with open reduction and mini-plate fixation from April 2010 to December 2014. There were 18 males and 10 females, with age range of 21-60 years(mean, 34.3 years). Causes of injury were falls in 21 cases and traffic accidents in 7 cases. According to the O’Driscoll classification, there were 14 cases of type Ⅰ, 11 cases of type Ⅱ and 3 cases of type Ⅲ. Time from injury to operation was 2-10 d(mean, 3.7 d). Reduction loss, fracture healing time and complications were documented.Elbow function was evaluated at the last follow-up by Mayo elbow performance score(MEPS)and Broberg & Morrey score. Results All cases were followed up for 12-25 months(mean, 15.1 months). Restricted elbow activity was initiated one week after operation. Bone united in mean 10.6 weeks(range, 8-14 weeks). No nerve injury or fracture redisplacement occurred. At the final follow-up, mean flexion was(124±15)°(range, 90°-140°), mean extension loss was(18±20)°(range, 0°- 50°), mean pronation was(65±18)°(range, 40°- 85°), and mean supination was(63±16)°(range, 35°- 85°), showing significant difference in comparison with the preoperative measure(P<0. 05). According to the MEPS, the results were excellent in 17 cases, good in 8, fair in 2 and poor in 1. According to the Broberg & Morrey score, the results were excellent in 16 cases, good in 8, fair in 3 and poor in 1. Conclusion Through anteromedial approach, mini-plate fixation of the ulnar coronoid process fracture provides rigid fixation, which benefits joint stability and bone union, and allows early functional exercise. Key words: Unlar fractures; Fracture fixation, internal; Mini-plate

AN ANTERIOR NEUROVASCULAR INTERVAL APPROACH FOR FIXATION OF ULNA CORONOID PROCESS FRACTURE

To investigate the advantages and effectiveness of anterior neurovascular interval approach for fixation of ulna coronoid process fracture. Between February 2011 and April 2015, 8 patients with ulna coronoid process fracture were treated with open reduction and internal fixation by anterior neurovascular interval approach. There were 5 males and 3 females, aged from 14 to 62 years (mean, 34 years). Fractures were caused by falling in 5 cases, traffic accident in 2 cases, and crashing in 1 case. The time between injury and operation was 1-6 days (mean, 3.5 days). According to Adams classification, there were 4 cases of type II, 1 case of type III, 2 cases of type IV, and 1 case of type V. In 1 patient with joint instability, lateral collateral ligament repair was given through another incision after fixation of coroniod fracture and the hinged external fixator, and plast splin was used to fix in the other patients; function exercise was done after removal of external fixtion. All incisions healed by first intention, and no complications of neurovascular injury and deep infection occurred. All patients were followed up 6-48 months (mean, 22 months). The healing time of fracture was 8-15 weeks (mean, 12.6 weeks). Mild myositis ossificans occurred in 1 case. The flexionextension arc of the elbow was (125.00±7.07)° and the forearm rotation was (135.00±7.07)°, showing no significant difference when compared with those of normal side[(126.88±7.53)° and (139.38±8.21)°] (t=0.469, P=0.654; t=2.198, P=0.054). According to Morrey's scale, the results were excellent in 6 cases, good in 2 cases; the excellent and good rate was 100%. Anterior neurovascular interval approach for reduction and internal fixation of ulna coroniod fractures has the advantages of simple operation, less trauma, and larger operative field. It can be used alone or combined with other surgical approaches.

Mandibular coronoid process fractures: Prevalence and characteristic multidetector CT findings

AimThe aim of this study was to investigate the prevalence and characteristic multidetector computed tomography (CT) (MDCT) findings of mandibular coronoid process fractures. MethodsA retrospective study was conducted on 376 patients with maxillofacial fractures who underwent 64-MDCT. For patients with mandibular coronoid process fractures, age, gender, cause of injury, coronoid process fracture location, and other maxillofacial fracture location were analyzed. ResultsOf all patients with maxillofacial fractures, 1.6% had mandibular coronoid process fractures. All patients with mandibular coronoid process fractures sustained other maxillofacial fractures as well. Furthermore, five (83.3%) of six patients with mandibular coronoid process fractures also had posterior maxillary sinus fractures. ConclusionsThe results of the present study indicate the prevalence and characteristic MDCT findings of mandibular coronoid process fractures. Patients with mandibular coronoid process fractures may sustain other maxillofacial fractures, especially posterior maxillary sinus fractures.

Treatment of fracture of radial head combined with bony instability around the elbow

Objective To investigate the therapeutic strategies of radial head fracture combined with bony instability around the elbow. Methods From January 2003 to June 2011, 31 patients with radial head fracture combined with bony instability around the elbow were treated. They were 21 males and 10 females, from 20 to 65 years of age (average, 42.6 years). Ulnar coronoid process fracture was found in 11 patients, ulnar olecranon fracture in 14 and capitellum fracture in 6. The radial head fracture was Mason type Ⅱ in 13 patients and Mason type Ⅲ in 18. All patients with radial head fracture were treated with mini-plate or screws. The 3 cases of ulnar coronoid process fracture of typeⅠ received conservative treatment when there was no displaced fracture fragment, or surgery after removal of the fragments in the joint and suture of the capsule. The 7 cases of type Ⅱand type Ⅲ fractures received internal fixation with Kirschner wire or micro-plate after the anterior bundle of the ulnar collateral ligaments (UCL) were repaired. Bone and ligament reconstructions were necessary to rebuild elbow stability in one patient with type Ⅳ fracture. For the ulna olecranon fractures, Kirschner wire with tensile band was used in non-comminuted ones, or plate and screw fixation and bone graft in the 6 comminuted ones. The 6 cases of type I capitellum fracture were treated with compression screw fixation. Results All wounds healed at the primary stage. All fractures united after 3 to 6 months (average, 5.1 months). All the patients were followed up for 18 to 36 months (average, 24.3 months). Traumatic osteoarthritis occurred in 3 cases, and mild heterotopic ossification in 4. The mean range of motion (ROM) of the affected elbow joint was 104°, and the ROM of forearm rotation was 118°. According to Broberg & Morrey evaluation system, the elbow function was rated as excellent in 7 patients, good in 15, fair in 6 and poor in 3. The excellent and good rate was 71.0% . Conclusions In order to achieve good functional restoration of the elbow joint, the radial head fractures should be anatomically reduced and internally fixated with mini-plate or screws. Injury to the bony structures around the elbow, such as ulnar coronoid process fracture, ulnar olecranon fracture and capitellum fracture, must be repaired or reconstructed. Key words: Elbow joint; Radius fractures; Joint instability

Rare Fracture of Coronoid Process Along with Zygomatic Complex Fracture- A Case Report

Rare Fracture of Coronoid Process Along with Zygomatic Complex Fracture- A Case Report

Stress Fracture and Nonunion of Coronoid Process in a Gymnast.

Background. Gymnasts have high mechanical loading forces of up to 14 times body weight. Overuse lesions are typical in wrists and stress fractures in the olecranon, while isolated fractures of the coronoid process are uncommon. We present a case of retraumatized nonunion stress fracture of the ulnar coronoid process. Case Description. A 19-year-old gymnast presented with elbow pain after training. Imaging confirmed an old fracture of the coronoid process. We describe a 6-month multiphase return to competition rehabilitation program, which allowed him to compete pain-freely. Literature Review. Acute and overuse injuries in gymnasts are known but no nonunion of the coronoid process has been described before. Only one case of stress fracture of coronoid process in a gymnast was reported. Purpose and Clinical Relevance. We could successfully and conservatively return to sport a reactivated nonunion of a stress fracture of the coronoid process.

Fractura-luxación del complejo distal del codo, ¿es la tétrada terrible una nueva entidad?

ObjectiveTo describe the terrible tetrad and treatment algorithm in patients and cadaver models to differentiate it from other entities that affect the distal elbow complex and the differences in their treatment. Material and methodologyWe studied 7 patients (5 women and 2 men) with a mean age of 51 years, who had had posterior or posterolateral elbow dislocation associated with fracture of coronoid process, radial head and olecranon. We reproduced the lesional association tetrad in 3 cadaveric specimens. Treatment included the reduction and stabilization of the coronoid process. We appreciate the clinical results with Broberg and Morrey scales and DASH. ResultsOf the 7 patients who underwent surgery, 4 had to be re-operated. The average functional outcome with Broberg and Morrey scale was fair, 77 (96-38) points, and the DASH was 30 (78-10). The range of flexion and extension was 96° (range 120-45°) and pronosupination of 126° (range 150-40°), mean supination of 57° (range 70-40°) and pronation 48.5° (range 60-30°). ConclusionIn the terrible elbow tetrad the main challenge is the correct preoperative diagnosis and good results are obtained with a stable elbow through proper surgical planning, individualizing rebuilding and repairing articular surfaces and ligamentous structures in a single approach.

Sport-Related Maxillo-Facial Fractures

Sports and exercise are important causes of maxillofacial injuries. Different types of sports might differ in frequency and type of fractures. The aim of the present study was to explore the possible relation between the types of sport practiced and the frequency and nature of the facial bone fractures of patients presenting in an oral and maxillofacial surgery department of a Dutch university center. This study is based on an analysis of patient records containing maxillofacial fractures sustained between January 1, 2000 and April 1, 2014 at the Vrije Universiteit University Medical Center (VUmc) in Amsterdam, The Netherlands. The present study comprised data from 108 patients with 128 maxillofacial fractures. Seventy-nine percent of the patients were male and 21% were female. The patients ranged in age from 10 to 64 years old with a mean age of 30.6 ± 12.0. The highest incidence of sport-related maxillofacial fractures occurred in individuals between the ages of 20 and 29. The most common sport-related fractures were zygoma complex fractures, followed by mandible fractures. Soccer and hockey were the most prominent causes of sport-related maxillofacial trauma in the present study. Coronoid process fractures were only observed in soccer players and not in other sports groups. Mandible angle fractures were relatively more frequent in rugby than in other sports. The results of this study suggest a relation between type of sport and the nature and frequency of the fractures it causes.

To cure coronoid process fractures of ulna through anterior approach of the elbow and frame shape plate internal fixation

To observe the effect of open reduction through anterior approach of the elbow and frame shape plate internal fixation in the treatment of coronoid process fracture of ulna. From August 2011 to October 2014, 17 patients with coronoid process fracture of ulna were treated with open reduction through anterior approach of the elbow and internal fixation with frame shape plate. There were 12 males and 5 females with an average age of 36.4 years old. A "S" shape anterior incision of the elbow was used to expose the fracture. The soft tissue of the bone block was kept intact and the fracture was fixed with internal frame shape plate. The therapeutic effects were evaluated by hospital for special surgery (HSS) elbow score system. All the patients were followed up for 8-26 months (average 14 months). The fractures clinically healed at an average time of 10 weeks (ranged from 9 to 11 weeks). There was no myositis ossificans happened. The patients' elbow joint function according to the HSS scores were 12 cases excellent (70.6%), good 4(23.5%) and moderate 1 (5.9%). The total excellent and good rate was 94.1%. Open reduction through anterior approach of the elbow and internal fixation with frame shape plate is effective to reach anatomical reduction in the treatment of the coronoid process fracture of ulna, with little damage and strong fixation.

Unusual case of medication related osteonecrosis (MRONJ): pathological fracture of coronoid process

Unusual case of medication related osteonecrosis (MRONJ): pathological fracture of coronoid process

Modified anterior approach for treatment of ulnar coronoid process fracture

Objective To investigate the clinical effect of modified anterior approach to manage fracture of the ulnar coronoid process via the space of brachial artery and vein with median nerve. Methods From June 2012 to January 2013, 11 patients with ulnar coronoid fracture were fixed via the modified anterior approach. The operation time, intraoperative blood loss and postoperative complications were recorded. Flexion and rotation range of motion about the injured and normal elbow were observed during postoperative follow-up period. Function of elbow joint was evaluated by mayo elbow performance index (MEPI). Results There was approximate 8 cm in length and 5 cm in width between the brachial vessels and median nerve. Operated angle from radial to ulnar side was fifty degrees and from proximal to distal end was sixty degrees. All the patients were available for follow-up. The fracture healed, that is the elbow flexion restored [(130.7±5.0)°] was 96.6% of the unaffected elbow, elbow extension restored [(7.6±8.1)°] was 84.0% of the unaffected elbow, pronation restored [(86.9±3.8)°] was 98.2% of the unaffected side, and supination restored [(85.6±6.0)°] was 96.7% of the unaffected side. MEPI of the elbow joint was over 75 points. Conclusion Modified anterior approach is relatively safe and simple in operation and results in satisfactory function recovery of the elbow joint, providing a new surgical approach for treatment of coronoid process fracture. Key words: Elbow joint; Ulna; Fracture fixation, internal

Radial head replacement or repair for the terrible triad of the elbow: which procedure is better?

The terrible triad of the elbow comprises an ulnar coronoid process fracture, a radial head (RH) fracture and posterior dislocation of the elbow. It is considered severe by many clinicians because it is difficult to repair and has a poor prognosis; therefore, it deserves more attention. Thirty-nine patients with terrible triad of the elbow characterized by a Mason type-III RH fracture were randomly divided into either an RH repair group (n = 19) or an RH replacement group (n = 20). The complication rates, radiological outcomes, Mayo Elbow Performance Score and range of motion of the elbow were analysed. Follow-up demonstrated no subluxation or recurrent dislocation of the elbow. Differences in surgery duration between the groups were significant (P < 0.001). The outcomes in terms of Mayo Elbow Performance Score (P = 0.009), flexion-extension arc (P = 0.01) and pronation-supination arc (P = 0.04) were significantly better in the RH replacement group. In addition, patients in the RH replacement group displayed significantly fewer post-surgery complications than those in the RH repair group (P = 0.04). Treating Mason type-III RH fracture in a terrible triad of the elbow with a metal RH prosthesis resulted in better clinical outcomes and fewer post-surgery complications than treating a terrible triad of the elbow by repairing it with screws or plates. RH replacement might be a more effective approach to better managing a terrible triad of the elbow.

Ipsilateral distal radius fracture with elbow dislocation-a rare entity: report of 3 cases

Introduction: Elbow joint is the second most common joint to dislocate after shoulder. 20 percent of elbow dislocations are associated with fractures. Elbow dislocations are commonly associated with coronoid process, radial head and olecranon fractures. Dislocations of the elbow commonly accompany proximal ulna or radial fracture. Elbow dislocation with a distal radius fracture is rare. In the literature, there are very few case reports highlighting such an injury.We report three cases of ipsilateral closed dislocation at the elbow associated with a closed distal radius fracture presented to us over a period of three years. Elbow dislocation was managed by closed reduction in two cases, and k wiring was required in one case. For distal radius open reduction and internal fixation by a buttress plate was done for two cases, and one was managed conservatively. At 6 months of follow up patients had full range of movement of the elbow joint and complete union of the distal radius fracture.Therefore, clinical and radiological assessment of one joint above and below should be done in every case so that these injuries, although rare, should not be missed. In a case of elbow dislocation, a possibility of a distal radius fracture should be kept in mind. A very high degree of suspicion is required for such cases.

Critical analysis of olecranon fracture management by pre-contoured locking plates

BackgroundFractures of the proximal ulna are rare and usually managed surgically. Strong fixation of the harware is essential to obtain good outcomes. We report our experience with pre-contoured locking plate fixation of complex olecranon fractures and present a critical appraisal of the outcomes. HypothesisPre-contoured locking plates provide good outcomes, but their clinical tolerance may be limited in some instances. Materials and methodsFrom September 2009 to December 2011, 28 patients were managed using a pre-contoured locking compression plate (LCP®). Among them, 6 were excluded because of missing data, which left 22 patients (11 males and 11 females) with a mean age of 55.7 years, including 12 who were employed. The fracture was on the dominant side in 11 patients. According to the Mayo Clinic classification, 15 fractures were type II and 7 type III. In addition to the ulnar fracture, a radial head fracture was present in 9 patients and a coronoid process fracture in 5 patients. Functional recovery was assessed using the Broberg-Morrey score and Mayo Elbow Performance Score (MEPS). Radiographs were obtained to evaluate the quality of fracture reduction and fracture healing, as well as to look for ossifications and osteoarthritis. ResultsMean follow-up was 20 months. Flexion was 131°, extension loss was 9.5°, pronation was 79°, and supination was 80.5°. The mean Broberg-Morrey score was 96.7 and the mean MEPS score 96.6. Fracture healing occurred in all patients, within a mean of 10.6 weeks. Evidence of early osteoarthritis was found in 6 patients, ossifications in 3 patients, and synostosis in 1 patient. An infection was successfully treated with lavage and antibiotic therapy in 1 patient. The fixation hardware was removed in 6 patients. No prognostic factors were identified. Discussion-conclusionOur hypothesis was confirmed. The outcomes are encouraging and comparable to those reported in the literature. The critical issue is the limited clinical tolerance of the plate with a high rate of posterior impingement requiring plate removal (27%). Rigorous technique is essential during plate implantation. Level of evidenceLevel IV, retrospective study.

Anatomy, definition, and treatment of the "terrible triad of the elbow" and contemplation of the rationality of this designation.

In the realm of orthopaedics, the terrible triad of the elbow is infamous, not simply because the prognosis is poor for most patients, but also, maybe to a greater extent, because the unique name of this malady attracts considerable attention and interest in both doctors and patients. The adjective terrible is bestowed on an elbow triad that comprises three coexisting complicated traumas; namely, radial head and ulnar coronoid process fractures and posterior dislocation of the elbow joint. In this review, the classification, treatment principles and prognosis for different forms of management of the radial head and ulnar coronoid process fractures and the ligaments lesions are introduced sequentially and various surgical procedures and their efficacy are discussed. This triad has long given orthopedic surgeons headaches. Nonetheless, in recent years a series of anatomical mechanical studies on the elbow joint have been published and there have been several breakthroughs in surgical techniques for managing this elbow triad. This review examines some memorable millstones and unveils trends in the current clinical norm for this triad. The accomplishments achieved recently have reportedly resulted in enhanced prognoses in the last two or three years compared with previous years. It is therefore high time to revise our thoughts about the justice and accuracy of defining this triad of the elbow as terrible. Lastly, we may safely conclude that the terrible triad of the elbow is much less terrible than previously, provided the commonly approved clinical approaches are undertaken.