Functional Outcome of Surgically Treated Isolated Coronoid Fractures With Elbow Dislocation in Young and Active Patients

Abstract

Coronoid fractures are less frequent injuries seen in around one-tenth of patients with elbow dislocation. Any injury to the coronoid process can be associated with elbow instability, in which injury to collateral ligaments co-exists, resulting in a loss of congruency of the elbow joint. However, there is a scarcity of evidence regarding patients' management with elbow dislocation and associated coronoid fractures. So, our aim is to assess the functional outcome of the elbow after operative fixation in patients with any type of coronoid fracture with associated elbow dislocation. A total of six patients with closed coronoid fracture of the elbow, with associated elbow dislocation, without any other associated trauma or previous surgery to the same limb, were included in our study. After closed reduction, patients with an incongruent reduction of the elbow joint were operated. The injured structures were repaired in an inside-out sequence: the coronoid fragment was first reduced by using a lasso-type suture. The larger fragments of the coronoid were fixed with either a screw or a plate when deemed necessary. Then, the lateral collateral ligament was repaired either using a suture anchor or transosseous (No. 2 Arthrex; Naples, Florida) sutures. After repair, the elbow was examined for stability radiologically using the hanging arm test; a concentric reduction of the elbow in lateral view during this test indicates a stable elbow. All patients showed a good to excellent outcome on the Mayo elbow performance score (MEPS) at the final follow-up (three patients had an excellent score while three had a good score). At the final follow-up, mean elbow flexion was 124º, loss of extension was 10º in only one patient, mean supination was 80º, and mean pronation was 72º. Isolated fractures of the coronoid associated with elbow dislocation require appropriate evaluation and management. Closed reduction and immobilization alone in young and active patients may not be sufficient, especially in patients with incongruent ulnohumeral joint. Surgical fixation of the coronoid fragment and repair of the collateral ligament, whenever indicated, can provide good functional outcomes.

Humeral trochlear morphology does not influence coronoid fractures in elbow dislocation

“…Very few authors have studied CED with isolated coronoid fractures. Kumar et al [7] have described a series of 6 young patients who got injured by falling on an outstretched hand and were treated by operative fixation. Their study highlighted the fact that only 10% of elbow dislocations presents with isolated coronoid fracture.…”

“…Coronoid fractures can be considered both the direct consequence of posterolateral elbow dislocations and the cause of residual post‐traumatic elbow instability; it is commonly accepted that the severity of coronoid fractures correlates directly with the severity of elbow instability. Very few authors have studied isolated coronoid fracture in association to elbow dislocation [6, 7].…”

A novel and superior Lasso-plate technique in treatment for coronoid process fracture in the terrible triad of elbow

“…After fixation of the coronoid, fixation or replacement of radial head and repair of the LCL complex was accomplished, the stability of the elbow was evaluated by using the hanging arm test 13 , 15 , 19 . From the perspective of intraoperative lateral view, if concentric reduction of humeral ulnar joint could be maintained with the weight of the hand and forearm acting as a dislocating force, the elbow was thought to be the stability.…”

Anatomical and Biomechanical Stability of Single/Double Screw‐Cancellous Bone Fixations of Regan–Morry Type III Ulnar Coronoid Fractures in Adults: CT Measurement and Finite Element Analysis

“…For larger fractures, surgeons can choose lag screw fixation methods directed anterior to posterior or vice versa. [5][6][7][8] Since the proximal ulna is covered with thin cortex and loose spongiosa, especially in patients with osteoporosis, problems such as screw loosening, displacement or rotation of the fracture block, and screws stripping may occur when the single or plural screws are improperly fixed. [9][10][11][12] To avoid problems with a single screw, double lag screws sometimes can be used to enhance fixation stability.…”

“…Methods of internal fixation for ulnar coronoid fractures include Kirschner wires, tension screws (cancellous bone screws), mini plates, anchor and suture “lasso” techniques. For larger fractures, surgeons can choose lag screw fixation methods directed anterior to posterior or vice versa 5–8 . Since the proximal ulna is covered with thin cortex and loose spongiosa, especially in patients with osteoporosis, problems such as screw loosening, displacement or rotation of the fracture block, and screws stripping may occur when the single or plural screws are improperly fixed 9–12 .…”