Coronoid Process and Monteggia Fractures

Optimal Screw Orientation for Fixation of Coronoid Fractures

“…A tip subtype 2 fracture was simulated by transverse osteotomy at the midpoint of coronoid height decided by a line from the tip of the olecranon across the base of coronoid which is parallel to the long axis of the ulna. 15 The osteotomies were performed with a power saw at the periphery and completed with an osteotome to simulate a fracture surface by creating interdigitation. The specimens of a pair were then randomized to be fixed with an AP screw in one specimen and a PA screw in the other.…”

Traumatic Elbow Injuries: What the Orthopedic Surgeon Wants to Know

“…The mechanism of fracture is thought to relate to axial loading translating to shear stress on the coronoid process (2,4,5), conditions that are commonly seen in FOOSH-type injuries (Movie 5 [online]). Isolated coronoid process fractures are uncommon; most coronoid process fractures occur in the context of elbow dislocation and are associated with comminuted proximal ulna fractures and radial head fractures (5,42). Coronoid process fractures have been classically defined within the Regan and Morrey classification system (43), according to the percentage of the process fractured in the horizontal (shear) plane.…”

“…Monteggia injuries are classified within the Bado system (60) on the basis of the direction of dislocation, angulation of the ulnar fracture fragment, and the presence or absence of an associated fracture of the radius (Fig 24). Various mechanisms have been described as possible causes of Monteggia-type injuries, but it is generally believed that a direct blow to the ulna, or FOOSH with the forearm in pronation or hyperextension, produces most Monteggia fracture patterns (3,42,61). Various mechanisms have been described as possible causes of Monteggia-type injuries, but it is generally believed that a direct blow to the ulna, or FOOSH with the forearm in pronation or hyperextension, produces most Monteggia fracture patterns (3,42,61).…”

“…Historically, nonsurgical treatment methods were recommended for adults; however, the emphasis is now placed on early surgical repair of most Monteggia fractures (62). Delayed recognition of radial head dislocation can lead to chronic instability and further injury (3,42). Delayed recognition of radial head dislocation can lead to chronic instability and further injury (3,42).…”

“…Recent reports have shown improved outcomes after surgical intervention (62)(63)(64), with prompt detection of these injuries allowing appropriate early intervention. Radiography generally suffices to characterize the ulnar fracture component, but the associated radiocapitellar dislocation can often be missed, particularly if spontaneous reduction occurs before radiography is performed (42,65,66). Radiography generally suffices to characterize the ulnar fracture component, but the associated radiocapitellar dislocation can often be missed, particularly if spontaneous reduction occurs before radiography is performed (42,65,66).…”