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

Abstract

The treatment of ulna coronal process fractures in the terrible triad of elbow, especially type I and II Regan-Morrey coronoid fractures, still have been controversial. The purpose of this retrospective study was to evaluate the novel Lasso-plate technique to have a more reliable fixation and a well clinical outcomes for type I and II Regan-Morrey coronoid fractures in a terrible triad of the elbow (TTE). Patients with simple TTE, closed fracture, aged > 18 years, duration of injury < 2 weeks, type I and II Regan-Morrey coronoid process fracture fixed by the Lasso-plate technique or ORIF were enrolled in the study. Total 144 patients with type I and II Regan-Morrey coronoid fracture in TTE were included in the Lasso-plate group or ORIF (open reduction and internal fixation) group in the Xi'an Honghui Hospital from January 2017 to December 2020. Eighty-six patients in Lasso-plate group underwent surgery using a novel Lasso-plate technique. And other 58 patients in ORIF group underwent surgery using ORIF. The data of two groups, including the X-ray films, Computed tomography (CT), the range of elbow motion, Mayo Elbow Performance Score (MEPS) and the surgical complications, were extracted from the hospital's patient records. All patients in both groups were followed up at least 12 months. The mean operation time (88.2 ± 12.3 min) in Lasso-plate group is shorter than that of ORIF group (109.1 ± 13.0 min). There was one patient with injury of deep branch of radial nerve and one patient with superficial surgical incision infection in Lasso-plate group. There were two patients with surgical incision infection in ORIF group. There were three heterotopic ossifications in Lasso-plate group and eight heterotopic ossifications in ORIF group. There were 5 elbow joints stiffness in Lasso-plate group and 12 in ORIF group. At 12 months follow up, the mean range of flexion-extension motion in Lasso-plate group was 122.9° ± 13.4° versus 113.2° ± 18.1° in ORIF group (p < 0.01), the mean 89.7 ± 5.6 MEPS in Lasso-plate group versus mean 83.7 ± 6.1 MEPSin ORIF group. The fixation of coronoid process fracture in TTE by the Lasso-plate technique, especially type I and II Regan-Morrey coronoid fracture, could be easier to master and operate, could provide the sufficient stability of elbow joint to enable early functional exercise, along with a better clinical outcome, a lower surgical complication. For the treatment of TTE, we recommend the fixation of type I and II Regan-Morrey coronoid fracture with the Lasso-plate technique, which would result in a better clinical outcome.

Figure 1

Schematic of Lasso-plate surgical technique. (a) Type II Regan–Morrey coronoid fractures. (b) A 2.0-mm K-wire or drill was used to drill the tunnels from dorsal ulna to coronoid process. (c) The tunnels were located on both sides of the fracture fragment of coronal process fracture. (d) Then to take a hollow lumbar puncture needle and insert it into the bone tunnel. (e) The Lasso-plate was placed in the gap between the coronoid and the anterior capsule, then the wire tails of Lasso-plate were introduced to passing through the tunnels from the anterior to the posterior. (f) The fracture was reduced and fixed when the steel wire was tightened.

Figure 2

Radiological image of typical patient with TTE using Lasso-plate technique. The preoperative anteroposterior X-ray (a1) and lateral X-ray (a2) showed the posterior dislocation of left elbow joint, the fracture of radial head and coronoid process. An anteroposterior X-ray (b1) and lateral X-ray (b2) at postoperative follow-up showed that the fracture of coronoid process was reduced and fixed by Lasso-plate technique, radial head fracture was fixed by miniplate, and the LCL of elbow were repaired by suture anchor. An anteroposterior X-ray (c1) and lateral X-ray (c2) at 6-months postoperative follow-up showed that fracture had healed well and the dislocation and instability of elbow were not observed.

Figure 3

Radiological image of typical patient with TTE using ORIF. The preoperative anteroposterior X-ray (a1) and lateral X-ray (a2) showed the posterior dislocation of right elbow joint, the fracture of radial head and coronoid process. An anteroposterior X-ray (b1) and lateral X-ray (b2) at postoperative follow-up showed that the fracture of coronoid process and radial head were fixed by miniplate and the LCL and MCL of elbow were repaired by suture anchor. An anteroposterior X-ray (c1) and lateral X-ray (c2) at 6-months postoperative follow-up showed that fracture had healed well and the dislocation and instability of elbow were not observed.