Coronoid fractures and traumatic elbow instability

Huub H de Klerk; David Ring; Lex Boerboom; Michel P J van den Bekerom; Job N Doornberg

doi:10.1016/j.jseint.2023.03.020

Coronoid fractures and traumatic elbow instability

JSES Int. 2023 Apr 20;7(6):2587-2593. doi: 10.1016/j.jseint.2023.03.020. eCollection 2023 Nov.

Authors

Huub H de Klerk^{1

2

3}, David Ring⁴, Lex Boerboom³, Michel P J van den Bekerom^{2

5}, Job N Doornberg³

Affiliations

¹ Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
² Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands.
³ Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁴ Department of Surgery and Perioperative Care, The University of Texas at Austin, TX, USA.
⁵ Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

Abstract

The coronoid process is key to concentric elbow alignment. Malalignment can contribute to post-traumatic osteoarthritis. The aim of treatment is to keep the joint aligned while the collateral ligaments and fractures heal. The injury pattern is apparent in the shape and size of the coronoid fracture fragments: (1) coronoid tip fractures associated with terrible triad (TT) injuries; (2) anteromedial facet fractures with posteromedial varus rotational type injuries; and (3) large coronoid base fractures with anterior (trans-) or posterior olecranon fracture dislocations. Each injury pattern is associated with specific ligamentous injuries and fracture characteristics useful in planning treatment. The tip fractures associated with TT injuries are repaired with suture fixation or screw fixation in addition to repair or replacement of the radial head fracture and reattachment of the lateral collateral ligament origin. Anteromedial facet fractures are usually repaired with a medial buttress plate. If the elbow is concentrically located on computed tomography and the patient can avoid varus stress for a month, TT and anteromedial facet injuries can be treated nonoperatively. Base fractures are associated with olecranon fractures and can usually be fixed with screws through the posterior plate or with an additional medial plate. If the surgery makes elbow subluxation or dislocation unlikely, and the fracture fixation is secure, elbow motion and stretching can commence within a week when the patient is comfortable.

Keywords: Dislocation; Olecranon fracture dislocation; Pattern of injury; Posteromedial varus rotational type injury; Subluxation; Terrible triad; Treatment; Ulnohumeral.

Publication types

Review