Conservative Treatment Versus Fixation of Type I Coronoid Fracture in Terrible Triad Injuries of the Elbow Joint

Abstract

Background:The coronoid process is considered the keystone of bony elbow stability, in addition to its soft tissue attachment. Aim of the work:To compare conservative treatment versus fixation of type I coronoid fracture in terrible triad injuries as regard elbow stability, functional outcome, and possible complications. Patients and methods:We performed a prospective randomized control study on 20 patients with terrible triad injuries and were divided into two equal groups. Randomization was done using Microsoft Excel. Group (1) including 10 patients where the coronoid fracture was not repaired, and Group (2) including 10 patients where the coronoid fracture was repaired. All patients were operated using the lateral approach. In the second group, the coronoid fracture was fixed using pull-out sutures. In both groups, internal fixation was done for the radial head or neck fracture with reattachment of the lateral ulnar collateral ligament (LUCL) to its humeral origin by transosseous sutures. Postoperative patient assessment was done according to the Disabilities of the Arm, Shoulder and Hand (DASH) Score, and the Broberg-Morrey rating system. Results:In the first group, the mean Broberg-Morrey score was 91.2 (range, 85-98) with four excellent results and six good results. The average DASH score was 13 (range, 2.5-30). In the second group, the mean Broberg-Morrey score was 94.4 (range, 89-98) with seven excellent results and three good result. The average DASH score was 9.6 (range, 0-23.3).Two patients experienced postoperative complications in the first group, one implant failure of the radial neck fracture after 3 weeks follow up and the other did not reach complete union of his radial neck. Both patients refused a second operation. Conclusion:We conclude that fixation of type I coronoid fractures in terrible triad injuries did not show significant difference regarding elbow stability and clinical outcome at short-term follow up.