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

Coronoid fractures and traumatic elbow instability

Huub H de Klerk  1   2   3 , David Ring  4 , Lex Boerboom  3 , Michel P J van den Bekerom  2   5 , Job N Doornberg  3
Affiliations
Review

Coronoid fractures and traumatic elbow instability

Huub H de Klerk et al. JSES Int. .

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.

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Figures

Figure 1
Figure 1
Mayo classification of coronoid process fractures. Used with permission of The Bone & Joint Journal, from de Klerk HH, Oosterhoff JHF, Schoolmeesters B, Nieboer P, Eygendaal D, Jaarsma RL, IJpma FFA, van den Bekerom MPJ, Doornberg JN; Traumaplatform 3D Consortium. Recognition of the pattern of complex fractures of the elbow using 3D-printed models. Bone Joint J. 2023 Jan;105-B(1):56-63.; permission conveyed through Copyright Clearance Center, Inc.
Figure 2
Figure 2
Elbow fracture patterns with coronoid involvement (Top row = X-ray, Middle row = 2D-CT, Bottom row = 3D-CT).
Figure 3
Figure 3
Guiding the suture for fixation.
Figure 4
Figure 4
Buttress plate for anteromedial facet fracture.
See this image and copyright information in PMC

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