Results of arthroscopically assisted reduction and fixation of anteromedial facet coronoid fractures at short-term follow-up

Colozza, Alessandra; Menozzi, Margherita; Perna, Luigi; Cavaciocchi, Michele; Martini, Ilaria; Galavotti, Cristina; Padovani, Sara

doi:10.1016/j.jse.2022.03.026

Cited by 10 publications

(11 citation statements)

References 33 publications

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“…Lee et al 29 and Hausman et al 17 observed no HO, while Adams et al 1 reported asymptomatic HO in 1 (1/7; 14.3%) patient. Colozza et al 7 identified HO on the medial side of the elbow in 2 (6.3%) of 32 patients but without clinical consequences. In the present study, of the 3 (3/23; 13.0%) patients who developed HO, mostly on the medial side of the elbow, after arthroscopy for fracture-dislocations, 1 patient underwent repeated surgery for HO removal, while the other 2 experienced no clinical consequences.…”

Section: Discussionmentioning

confidence: 98%

Prevalence, Timing, Locational Distribution, and Risk Factors for Heterotopic Ossification After Elbow Arthroscopy

Ben,

Kholinne,

Zeng

et al. 2023

Am J Sports Med

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Background: Arthroscopic techniques aim to reduce complications and accelerate recovery of the elbow after treatments for posttraumatic stiffness, arthritis diseases, lateral epicondylitis, ligament reconstruction, and elbow trauma. However, data on the true prevalence and characteristics of heterotopic ossification (HO) formation after elbow arthroscopy are limited. Purpose: To investigate the prevalence, timing, locational distribution, and risk factors of HO after elbow arthroscopy. Study Design: Cohort study; Level of evidence, 4. Methods: Data on 205 patients undergoing elbow arthroscopy by a single senior elbow surgeon at a single institution between May 2011 and January 2022 were retrospectively reviewed. The patients were evaluated at 2 weeks, 8 weeks, 6 months, and then annually after surgery or more frequently if HO developed, with a minimum of 1 year of postoperative follow-up. Postoperative anteroposterior and lateral elbow radiographs were taken at 2 weeks to rule out fracture and at 8 weeks to identify HO. The clinical outcomes were evaluated based on the pain visual analog scale; the shortened version of the Disabilities of the Arm, Shoulder and Hand score; Mayo Elbow Performance Score; and the Single Assessment Numeric Evaluation scores before and after surgery. Bivariate logistic regression analyses were used to determine factors affecting HO prevalence. Results: Thirteen (12 male, 1 female) of 205 (6.3%) patients developed HO, with 10 (76.9%) with HO that formed on the medial compartment of the elbow. Ten (76.9%) patients were diagnosed at 8 weeks after arthroscopic surgery, 1 (7.7%) at 6 months after surgery, and 2 (15.4%) at 12 months after surgery. HO was not found at 2 weeks after surgery in any patient. The mean follow-up time was 3.5 years (range, 1.0-11.8 years). Eleven asymptomatic patients were treated nonoperatively, and 2 symptomatic patients underwent HO excision arthroscopically or had a combination of open surgery and arthroscopy. Age was a protective factor for HO formation (odds ratio [OR], 0.953; 95% CI, 0.910-0.999; P = .047). The risk factors for HO formation were tourniquet time (OR, 1.042; 95% CI, 1.019-1.065; P < .001) and surgical time (OR, 1.026; 95% CI, 1.011-1.041; P < .001). Conclusion: Among 205 patients who underwent elbow arthroscopy, HO was a minor complication of elbow arthroscopy, with a prevalence rate of 6.3%, and was usually located on the medial compartment of the elbow. Although the presence of HO may not affect the clinical outcomes in most patients, it should be carefully monitored for a minimum of 8 weeks postoperatively. Younger age, longer tourniquet time, and longer surgical time contributed to HO formation after elbow arthroscopy.

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Section: Discussionmentioning

confidence: 98%

Prevalence, Timing, Locational Distribution, and Risk Factors for Heterotopic Ossification After Elbow Arthroscopy

Ben,

Kholinne,

Zeng

et al. 2023

Am J Sports Med

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“…From the current literature, we can define clear indications for elbow arthroscopy, for example, the coronoid fractures. It is especially recommended for those affecting the anteromedial facet that would require a repair of the LCL and might need otherwise a double open approach [1][2][3][4]. Several authors have also reported good results in lateral condyle fractures or coronal shear fractures of the distal humerus [29].…”

Section: Introductionmentioning

confidence: 99%

The role of arthroscopy in the management of adult elbow trauma

Valencia,

Foruria

2023

J. exp. orthop.

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Fractures around the elbow are often challenging to treat and in most cases require an extensive approach. Since the development of elbow arthroscopy, most authors have pointed out the potential advantages of a less invasive technique that can be useful for visualization and reduction of the articular fragments with an eventual percutaneous fixation. Arthroscopic techniques provide a limited exposure that may lead to a faster wound healing, lower rate of complications and thus, better recovery of range of motion. However, elbow arthroscopy is also a demanding technique, especially in a swollen and fractured joint, and it is not exempt of risks. The overall rate of complications has been rated from 1.5% to 11% and nerve injury rates from 1.26–7.5%.The objective of this review is to present the arthroscopic setup and general surgical technique for the management of elbow trauma and to define some clear indications. Patient positioning and operating room display is key in order to obtain success. In addition to the arthroscopic equipment, fluoroscopy is almost always necessary for percutaneous fixation and precise preparation is mandatory. In the last decade, literature regarding new portals or surgical tips for arthroscopic treatment of elbow fractures have been published.The main indications for fracture arthroscopic-assisted fixation are those articular fractures involving the coronoid, distal humerus shear fractures in the coronal plane (trochlear and capitellum fractures) and, more controversially, those affecting the radial head. The treatment of these type of fractures all arthroscopically is exponentially demanding as it might also require ligament repair. For coronoid fractures, it can be useful in Morrey type II and III, and O´Driscoll anteromedial facet fractures associated to a posteromedial instability pattern that also require a repair of the LCL. Although excellent results have been published, comparative series are scarce. Radial head fractures can also be approached arthroscopically in simple non-comminute fractures that can be fixed percutaneously.In conclusion, arthroscopy of the elbow is an excellent tool to better understand and visualize articular fractures of the elbow. However, despite the advances in surgical technique, whether it improves clinical and radiological results is still to be proven.

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“…However, the optimal management of the comminuted coronoid fracture remains to be investigated due to its various injury patterns. 12 …”

Section: Introductionmentioning

confidence: 99%

“…Considering the serious risk of rapid post‐traumatic arthritis with the bony and soft tissue left untreated, the concept of “fracture‐fixation strategy” is stressed. However, the optimal management of the comminuted coronoid fracture remains to be investigated due to its various injury patterns 12 …”

Section: Introductionmentioning

confidence: 99%

“…However, the optimal management of the comminuted coronoid fracture remains to be investigated due to its various injury patterns. 12 Nowadays, the best fixation for coronoid fractures is debatable, 13,14 and fixation failure often leads to elbow instability, arthritis and stiffness. 15 Generally, the coronoid tip fracture is often treated by reattaching the anterior capsule with nonabsorbable sutures or wire securing through drill-holes in the fracture bed.…”

Section: Introductionmentioning

confidence: 99%

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A Novel Suture‐Preset Spring Plate System (SSPS) for Comminuted Coronoid Process Fracture in the Elbow

Yan

Xiang

et al. 2022

Orthopaedic Surgery

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Objective: This study is aimed to investigate the clinical outcomes of a novel SSPS for fixation of the comminuted coronoid fracture.Methods: A retrospective study was carried out in the patients with comminuted fractures of the coronoid treated by SPSS fixation between January 2014 and December 2018. A total of 17 patients (17 sides) was included in our study, including 11 male and six female, with a mean age range from 18 to 60. All cases started to functional rehabilitation immediately after the operation. Clinical outcomes were evaluated both radiographically and functionally at the followup visit, including the elbow instability, range of motion and Mayo elbow performance score (MEPS).Results: According to the O'Driscoll classification system, there was two side of type 1.2, two of type 2.1, four of type 2.2, three of type 2.3, two of 3.1 and four of type 3.2. The surgery was carried out by Kocher and anteromedial approach in 12 patients, posterior and anteromedial approach in four, anterior approach in one. The average operation time and intraoperative blood loss was 129.41AE43.87 min and 115.29AE104.65 ml. The median follow-up time was 9 months (range, 6 to 15 months). The mean flexion, extension, pronation and supination motion was 138.76AE8.67 degrees, 20.00AE13.58, 82.94AE5.32and 74.12AE14.39 respectively at final follow up. The mean MEPS score was 89.76AE8.46, including 11 excellent, 3 good and 3 fair result. The mean VAS score was 1.94AE0.97. The mean union time of coronoid fractures was 2.77AE0.31 months according to the established standard of healing. There were no significant differences in clinical outcomes among groups according to the O'Driscoll classification (P > .05) and ligament repair strategy (P > .05). No patient underwent instability or dislocation of the elbow during follow up. There were two cases with mild ulnar nerve symptoms which recovered totally at follow up. Meanwhile, there were three cases with heterotopic ossification of the elbow. Conclusion:Our findings demonstrated that the SSPS can provide a reliable fixation for the comminuted coronoid fracture with satisfactory clinical outcomes.

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Results of arthroscopically assisted reduction and fixation of anteromedial facet coronoid fractures at short-term follow-up

Cited by 10 publications

References 33 publications

Prevalence, Timing, Locational Distribution, and Risk Factors for Heterotopic Ossification After Elbow Arthroscopy

Prevalence, Timing, Locational Distribution, and Risk Factors for Heterotopic Ossification After Elbow Arthroscopy

The role of arthroscopy in the management of adult elbow trauma

A Novel Suture‐Preset Spring Plate System (SSPS) for Comminuted Coronoid Process Fracture in the Elbow

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