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. 2024 Oct 1;106-B(10):1150-1157.
doi: 10.1302/0301-620X.106B10.BJJ-2024-0359.R1.

Factors associated with the choice of treatment for coronoid fractures

Huub H de Klerk  1   2   3 , Lukas P E Verweij  2   4   5 , Job N Doornberg  3   6 , Ruurd L Jaarsma  6 , Tsuyoshi Murase  7 , Neal C Chen  1   8 , Michel P J van den Bekerom  2   9 ; and the Elbow Injury Management Consortium; and the Elbow Injury Management Consortium (EIMC); Kekatpure Al, Bhashyam Ar, Watts Ac, van T A, Alder-Price Ac, Turow A, Boonrod A, Masri B, The B, Jadav B, Mudgal Cs, Lameijer Cm, Langhammer Cg, Tu Cg, Rosso C, Ring D, Ruch Ds, Eygendaal D, Alentorn-Geli E, Kholinne E, Ek Et, Bain Gi, Lawton Jn, White Ja, Phadnis J, Alexander J, Sato K, Shimada K, Boerboom Al, Cohen Ms, Maruyama M, Ramsey Ml, Sandow Mj, Anantavorasakul N, Wallwork N, Schep Nwl, Arrigoni P, Mansat P, Barco R, Tosti Rj, van R R, Garg R, Siebenlist S, Dodds Sd, Thaveepunsan S, Matsuura T, Choi Y
Affiliations

Factors associated with the choice of treatment for coronoid fractures

Huub H de Klerk et al. Bone Joint J. .

Abstract

Aims: This study aimed to gather insights from elbow experts using the Delphi method to evaluate the influence of patient characteristics and fracture morphology on the choice between operative and nonoperative treatment for coronoid fractures.

Methods: A three-round electronic (e-)modified Delphi survey study was performed between March and December 2023. A total of 55 elbow surgeons from Asia, Australia, Europe, and North America participated, with 48 completing all questionnaires (87%). The panellists evaluated the factors identified as important in literature for treatment decision-making, using a Likert scale ranging from "strongly influences me to recommend nonoperative treatment" (1) to "strongly influences me to recommend operative treatment" (5). Factors achieving Likert scores ≤ 2.0 or ≥ 4.0 were deemed influential for treatment recommendation. Stable consensus is defined as an agreement of ≥ 80% in the second and third rounds.

Results: Of 68 factors considered important in the literature for treatment choice for coronoid fractures, 18 achieved a stable consensus to be influential. Influential factors with stable consensus that advocate for operative treatment were being a professional athlete, playing overhead sports, a history of subjective dislocation or subluxation during trauma, open fracture, crepitation with range of movement, > 2 mm opening during varus stress on radiological imaging, and having an anteromedial facet or basal coronoid fracture (O'Driscoll type 2 or 3). An anterolateral coronoid tip fracture ≤ 2 mm was the only influential factor with a stable consensus that advocates for nonoperative treatment. Most disagreement existed regarding the treatment for the terrible triad injury with an anterolateral coronoid tip fracture fragment ≤ 2 mm (O'Driscoll type 1 subtype 1).

Conclusion: This study gives insights into areas of consensus among surveyed elbow surgeons in choosing between operative and nonoperative management of coronoid fractures. These findings should be used in conjunction with previous patient cohort studies when discussing treatment options with patients.

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Conflict of interest statement

N. C. Chen reports funding from the Jesse B. Jupiter Research Fund of the Wyss Medical Foundation, related to this study. H. H. de Klerk reports travel grants for a research internship in Boston from De Stichting Prof. Michaël-van Vloten Fonds, Van Leersum Grant/KNAW Medical Sciences Fund from the Royal Netherlands Academy of Arts & Sciences, Marti-Keuning Eckhardt Foundation, Vreedefonds, the Stichting Anna Fonds | NOREF, the Stichting het Scholten-Cordes Fonds, Fundatie van Renswoude, and the USC Scholarship Foundation (all Netherlands), all related to this study. Each author certifies that he has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

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