Buttress plate fixation of coronoid process fractures via a medial approach

Abstract

PurposeTo assess the clinical and radiographic outcomes of coronoid process fractures surgically managed with buttress plate fixation via a medial approach.MethodsA retrospective review of all coronoid fractures surgically fixed in our institution using a buttress plate technique via a medial approach between June 2012 and April 2015 by the senior author was performed. These fractures were all sizeable fractures contributing to persistent elbow instability in terrible triad or varus posteromedial rotatory instability injury patterns. A prospective telephone questionnaire was conducted to assess patient outcomes using the disabilities of the arm, shoulder and hand (DASH) score and Mayo hlbow performance score (MEPS).ResultsTwelve patients were included in the study, comprising 10 males and 2 females with an average age of 39 years (range, 19–72 years). Mean follow-up was 16 months (range, 4–18 months). The average time to radiographic union was 4 months (range, 3–7 months). Range of motion measurements at final follow-up were obtained in 11 out of 12 patients, with one patient defaulting follow-up. All 11 patients displayed a functional elbow range of motion of at least 30°-130°, with an average arc of motion of 130° (range, 110° −140°), mean elbow flexion of 134° (range, 110° −140°) and mean flexion contracture of 3° (range, 0° −20°). The mean DASH score was 16 (range, 2.5–43.8) and the mean MEPS was 75 (range, 65–100). Complications observed included one patient with a superficial wound infection which resolved with a course of oral antibiotics and one patient with radiographic evidence of heterotopic ossification which was conservatively managed. No residual elbow instability was observed and no reoperations were performed.ConclusionButtress plate fixation via a medial approach of coronoid process fractures that contribute to persistent elbow instability represents a reliable method of treatment that produces satisfactory and predictable outcomes.

Results of standardized treatment of elbow fracture dislocations as per their injury pattern: a retrospective cohort of 89 patients

“…In a study by Muñoz et al, 18 the complication rate was 27%, with only 6 patients (9.7%) being subjected to reoperations, where 2 of them were reoperated because of postsurgical stiffness. In another study, Lor et al 10 reported only 1 case of infection and 1 case of heterotopic ossification.…”

“…In another study reporting 8 patients with PMRV, all anteromedial coronoid fractures were fixed using a 1.5- or 2.0-mm “T” buttress plate. 10 They report an average flexion-extension arc of 130° and a MEPS evaluation of 75 points without reoperations or persistent instability at a short-term follow-up. These previous studies and ours shows the importance of performing an anatomic reduction and stable fixation of the anteromedial facet of the coronoid, allowing to recover the stabilizer role against posterior translation and posteromedial rotation.…”

The Novel Hooked Kirschner Wire Technique for Ulna Coronoid Process Fractures

“…Several surgical methods, such as suture lasso, 13 14) lasso plate, 15) screw fixation, 16) tension band wiring, 17) and buttress plate fixation, 18) have been introduced for coronoid fractures. Suture lassos have been widely used as an effective fixation method for smaller fragments.…”

Classification of coronoid process fractures: A pending question

“…Considering this fracture often results in early arthritis and elbow instability, most studies recommend internal fixation for AMFs. Surgical interventions of AMFs are controversial ( 24 , 35 , 36 ). Park ( 24 ) described the standard treatment for AMFs based on the acceptable clinical outcomes and elbow ROM after the management of 11 AMF fractures: LCL repairing alone for O'Driscoll type 2-1, fragments fixation with repairing LCL for O'Driscoll type 2-2, 2–3.…”

“…Whether to perform fracture fixation alone, ligament repair alone, or a combination of both depends on the size of the fracture and the extent of soft tissue damage. Buttress plate fixation via a medial approach was also a reliable method of treatment that produces satisfactory and predictable outcomes (36). However, some studies believe that even small fragments should be treated.…”