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. 2024 Jun 4:16:118439.
doi: 10.52965/001c.118439. eCollection 2024.

Coronoid fractures and complex elbow instability: current concepts

Panagiotis Masouros  1 , Petros Christoforos Christakakis  2 , Paraskevi Georgiadou  2 , Dimitrios Kourtzis  2 , Ioannis Moustakalis  2 , Nikolaos Papazotos  2 , Christos Garnavos  2
Affiliations

Coronoid fractures and complex elbow instability: current concepts

Panagiotis Masouros et al. Orthop Rev (Pavia). .

Abstract

Fractures of the coronoid process typically occur as part of more complex injury patterns, such as terrible triads, trans-olecranon fracture-dislocations, posteromedial rotatory injuries or Monteggia-like lesions. Each pattern is associated with a specific type of coronoid fracture with regard to shape and size and specific soft-tissue lesions. O' Driscoll classification incorporates those associations identifying three major types of fractures: tip, anteromedial facet, and basal fractures. The objective of this study is to review the most common types of complex elbow instability, identify the indications for coronoid fixation and guide the appropriate management. Tip fractures as those seen in terrible triads can conditionally left untreated provided that elbow stability has been restored after radial head fixation and ligaments repair. Anteromedial facet fractures benefit from a buttress plate, while large basilar fractures can be effectively secured with posteroanterior screws. Coronoid reconstruction with a graft should be considered in post-traumatic cases of chronic coronoid deficiency.

Keywords: anteromedial facet; coronoid; elbow instability; terrible triad; trans-olecranon fracture dislocation.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Figure 1.
Figure 1.. O’ Driscoll coronoid fracture classification
Figure 2.
Figure 2.. a) subtle coronoid fragments can easily be overlooked on initial x -rays (yellow arrow) b) post-op CT demonstrates escape of the coronoid fragment and non-concentric ulnohumeral reduction suggestive of persistent instability
Figure 3.
Figure 3.. a) coronoid as seen from the lateral side after RH osteotomy in case of a terrible triad injury b) coronoid approach from the medial side through FCU split in case of an anteromedial facet fracture c) coronoid from posterior side after reflecting the olecranon fragment in case of a posterior ulna fracture dislocation.
Figure 4.
Figure 4.. a) 3D image of a posterior ulna fracture dislocation with a comminuted coronoid fracture b) coronoid fixed with a pre-shaped medial buttress plate, olecranon double plating and LUCL re-attachment.
See this image and copyright information in PMC

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