Avulsion fracture of the supinator crest of the proximal ulna in the context of elbow joint injuries

Abstract

In a significant percentage of the population, a previously undescribed fracture fragment of the supinator crest of the ulna could be detected. The most frequently occurring associated injuries were fractures of the radial head, the coronoid process, and the distal humerus. The aetiology of these lesions is unknown; however, bony avulsion of the annular or the lateral ulnar collateral ligament seems to be the most likely cause. If this fragment is to be diagnosed by CT, the possibility of lateral or posterolateral instability should be considered.

Injuries to the Coronoid Process of the Ulna with Involvement of the Lesser Sigmoid Notch

“…Few case reports are available on injuries to the supinator crest and a following instability of the PRUJ 11 , 27 . These published cases only affect the posterior insertion of the annular ligament.…”

“…They found that a ligamentous injury to the lateral collateral ligaments in combination with an anteromedial coronoid fracture significantly destabilizes the elbow joint 7 . However, only few literature is available that addresses bony avulsion injuries of the annular ligament 9 , 10 , 11 . These injuries could be present if the insertion of the annular ligament on the anterior or posterior lesser sigmoid notch is affected in injuries to the proximal ulna.…”

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Elbow

“…In some patients, partial or complete avulsion of the posterior insertional segment of the annular ligament from the supinator crest of the ulna can be the cause of posterolateral elbow pain and/or click sensation. 44 As mentioned previously, the posterior attachment of the annular ligament can present as a superficial band in continuity with the periosteum of the ulna and a deep band in continuity with the cartilage of the ulnar notch. 42 For sure, both parts can be involved in pathological conditions.…”

“…During active/passive pronation and supination of the forearm, it is possible to visualize abnormal gliding or snapping of the annular ligament over the radial head 37 that may be related to several disorders including posttraumatic or congenital deformation of the radial head, nodular thickening of the ligament, posttraumatic hypertrophic scarring of the ligament, and intraligamentous calcific deposition. In some patients, partial or complete avulsion of the posterior insertional segment of the annular ligament from the supinator crest of the ulna can be the cause of posterolateral elbow pain and/or click sensation 44 . As mentioned previously, the posterior attachment of the annular ligament can present as a superficial band in continuity with the periosteum of the ulna and a deep band in continuity with the cartilage of the ulnar notch 42 .…”

The Osborne-Cotterill Lesion

“…In their article, the names of Osborne and Cotterill were related to the surgical technique for repairing the lateral 20 . In 2013, Schmidt-Horlohé et al, in a case series with computed tomographic examinations of the elbow, indicated that they categorized osseous ligamentocapsular avulsions at the dorsoradial aspect of the distal portion of the humerus as Osborne-Cotterill lesions 21 . In 2013, Englert et al cited the original article in relation to a method of ligamentous repair in a case of recurrent dislocation of the elbow 22 .…”