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. 2023 Dec 1;27(4):214-219.
doi: 10.1097/BTH.0000000000000444.

A Medial Approach That Provides Ample Exposure of the Coronoid for Fracture Management

Jorge L Orbay  1 , John J Heifner  2 , Robert R L Gray  3 , Francisco Rubio  1 , Nathan A Hoekzema  4 , Deana M Mercer  5
Affiliations

A Medial Approach That Provides Ample Exposure of the Coronoid for Fracture Management

Jorge L Orbay et al. Tech Hand Up Extrem Surg. .

Abstract

We describe a medial approach to the coronoid where the flexor-pronator mass is released from its humeral origin by creating a proximally based tendinous flap. This technique facilitates access to the coronoid, preservation of the medial collateral ligament origin, and repair of the flexor-pronator mass. This approach has utility for all coronoid fracture variations but especially the O'Driscoll anteromedial subtype 3, which includes fractures of the sublime tubercle, the anteromedial facet, and the coronoid tip.

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Conflict of interest statement

Conflicts of Interest and Source of Funding: J.L.O. discloses patents 8506606 and 8608741 issued to Skeletal Dynamics. Irrevocable trusts of which J.L.O. and his family members are the beneficiaries and own stock in Skeletal Dynamics, and Skeletal Dynamics reimburses expenses when J.L.O. speaks or presents on the company’s behalf. F.R., R.R.L.G., N.A.H., and D.M.M. disclose a relationship with Skeletal Dynamics that includes consulting and speaker’s bureau. D.M.M. discloses a relationship with Axogen that includes the speaker’s bureau. For the remaining author none were declared.

Figures

FIGURE 1
FIGURE 1
A 10 to 12 cm incision is made that begins 4 cm proximal (P) to the medial condyle (A). The ulnar nerve is identified proximal to the medial condyle (B). The Ligament of Osborne is released, and the humeral and ulnar heads of the flexor capri ulnaris are separated (C). The ulnar nerve is mobilized posteriorly, and the floor of the sheath, which overlies the sublime tubercle is incised. The ulna is exposed, taking care to maintain the insertion of the medial collateral ligament on the sublime tubercle (D).
FIGURE 2
FIGURE 2
The flexor-pronator mass is released from the medial condyle by creating a proximally based tendinous flap (A) and elevated to expose the anteromedial facet and tip of the coronoid (B and C).
FIGURE 3
FIGURE 3
The sublime tubercle fragment (*) is mobilized in continuity with the insertion of the anterior band of the medial collateral ligament (A), which is separated from the flexor-pronator mass (‡) (B).
FIGURE 4
FIGURE 4
The fractured fragment is provisionally pinned (A), then a medial coronoid plate and screws are applied for fixation (B). The flexor-pronator mass is repaired to the tendinous flap on the medial condyle (C), and the deep muscular layer is closed to protect the ulnar nerve (D).
FIGURE 5
FIGURE 5
Computed tomography (A) and 3-dimensional reconstruction (B) demonstrating an anteromedial facet fracture of the coronoid. A medial approach to the coronoid was used for internal fixation with a medial coronoid plate (C and D).
FIGURE 6
FIGURE 6
The medial approach utilizes a proximally based tendinous flap to release the flexor-pronator mass from the medial condyle (A and B). Following fracture fixation, the flexor-pronator mass is repaired to the tendinous flap (C).
FIGURE 7
FIGURE 7
Fluoroscopy demonstrating an unstable elbow with anteromedial facet fracture of the coronoid (A and B). Treatment consisted of an internal joint stabilizer implanted through a lateral approach and fracture fixation with a medial coronoid plate, implanted through a medial approach (C and D).
See this image and copyright information in PMC

References

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