Reconstruction of coronoid process of the ulna: a literature review

Abstract

As a pivotal part of the elbow joint structure, the coronoid process of the ulna plays a vital role in maintaining elbow joint stability. Loss of coronoid process height causes instability of the elbow joint depending on the fracture characteristics and size. The diagnosis and treatment of coronoid process fractures has gained widespread attention from orthopedic surgeons. Nevertheless, few reports have described reconstruction of coronoid process fractures and defects that affect elbow joint stability. Treatment of elbow joint instability induced by coronoid process defects is challenging because most cases are complicated by other elbow joint injuries. Moreover, the clinical efficacy remains unclear. The present narrative review was performed to examine the research progress on reconstruction of the coronoid process. The findings of this review provide evidence for clinical repair and reconstruction of coronoid process defects and contribute to the published literature on this topic.

Classification of coronoid process fractures: A pending question

“…If combined with osteoporosis or complex injuries, it is necessary to strengthen the fixation with hinge support or interlocking nail external fixation. Coronoid process reconstruction or prosthetic replacement is available when excessive bone loss or irreducible comminuted fragments ( 2 , 26 , 40 ).…”

Reconstruction of the coronoid process with the olecranon tip for chronic elbow dislocation in children: A rare case report and literature review

“…The coronoid process of the ulna plays a vital role in the stability of the elbow joint. As the primary osseous structure is related to the stability of the posterior elbow joint, the coronoid process not only resists the stress of the biceps, brachialis, and triceps brachii from the ulna to move backwards during flexion and extension (1)(2)(3), but also maintains the axial stability of the elbow joint and the stability of the posteromedial and posterolateral rotation (4,5). In addition, it can prevent the occurrence of elbow varus and valgus (6,7).…”

“…In addition, it can prevent the occurrence of elbow varus and valgus ( 6 , 7 ). In addition to these important functions related to bone structure, the coronoid process also provides attachment sites for multiple soft tissues ( 1 ). Therefore, coronoid defects of the ulna can cause not only acute and chronic joint instability, but also soft tissue instability ( 8 , 9 ), which leads to posterior or recurrent dislocations of the elbow followed by rapid degeneration to posttraumatic arthritis ( 5 , 10 , 11 ).…”

“…In general, open reduction and internal fixation with the lateral collateral ligament and possible medial collateral ligament repair are recommended for coronoid fracture ( 12 ). However, severe comminution coronoid fractures or old coronoid defects are difficult to repair directly, and coronoid reconstruction is required to restore elbow stability ( 1 , 13 ). Old coronoid process defects cannot be repaired with residual bone tissue due to bone resorption at the fracture site, resulting in elbow dislocation, traumatic arthritis, residual cubital varus deformity, and inability to perform open reduction and internal fixation of the coronoid process ( 5 ).…”

“…An ideal reconstruction material should have an articular cartilage surface that matches the elbow and a radius of curvature similar to that of the natural intact coronoid process to achieve a high healing success rate ( 1 ). Therefore, we selected the ipsilateral olecranon tip as the reconstruction material.…”