Reconstruction for elbow instability caused by congenital aplasia of the ulnar coronoid process—a case report. Highly comminuted type 3 fractures pose a significant problem during open reduction and internal fixation (ORIF) and may be better treated with a hinged external fixator. However, arthroscopy can make accurate positioning of the wire and insertion of the screw easier [23]. Minimal invasive surgery for coronoid fracture: technical note. No problem related to pronation or supination or elbow instability was reported in any patient (Fig. 5). CAS  No neurovascular damage after creation of an accessory anteromedial portal for arthroscopic reduction and fixation of coronoid fractures. However, our group of patients had sufficiently large fragments to allow screw fixation. a–h Exchange rod arthroscopic techniques for the reduction and fixation of fracture of the ulnar coronoid process: clean fracture surface, fracture reduction (a, b); exchange rod technique for midline approach (c, d); Kirschner wire pierced vertical to the bone (e, f); and screwed into the hollow screw (g, h). Hand Clin. Acta Orthop. At present, the consensus is to stabilize all fractures of the CP associated with elbow instability [8]. The goal of treatment is to obtain a stable, pain-free, and functional elbow. Smaller fractures associated with the “terrible triad” or varus posteromedial instability can be stabilized by “lasso-type” sutures through proximal ulnar drill holes or suture anchors both incorporating the fragment’scapsular attachment. The lateral cutaneous nerve of the forearm was carefully protected and tracted laterally with the skin and subcutaneous tissue. Eleven pairs of fresh-frozen cadaveric ulna were used. DPW, KOY, and WL performed the surgery for this study. The elbow extension in all five patients averaged −2° (range, −10° to 0°), while the average flexion was 140° (range, 135° to 145°). The patients gave their oral and written informed consent to the publication of their anonymous and clustered data and anonymous pictures. In cases where the fracture fragment is too small for screw fixation, some studies have reported that the use of cerclage suture fixation has achieved good results [21]. No blood vessel or nerve damage was observed during the 1-year follow-up period. When the elbow joint is bent, the tension on the peripheral nerves, blood vessels, and tendons is reduced and the biceps tendon can be pulled slightly inside to expose the surface of the coronoid process. Smaller fractures associated with the “terrible triad” or varus posteromedial instability can be stabilized by “lasso-type” sutures through proximal ulnar drill holes or suture anchors both incorporating the fragment’s capsular attachment. In fact, when these kinds of fractures show elbow joint instability, internal fixation is preferred [17]. Fractures of the ulnar coronoid process. A variety of operations for open reduction, internal fixation, and capsular repair require a larger incision [6, 16, 17, 20]. The lateral cutaneous nerves to the forearm and cephalic vein are comparatively shallow, so the incision is made in the skin alone, and dissected carefully. Elbow arthroscopy. c Biceps tendon. Instr Course Lect. The ulnar coronoid process plays a central role in maintaining elbow stability. Jeon IH, Oh CW, Kim PT. Clin Orthop Relat Res. Ouyang K, Wang D, Lu W, Xiong J, Xu J, Peng L, Liu H, Li H, Feng W. J Orthop Surg Res. However, not all these examinations can observe the positive signs regarding the instability. Department of Sports Medicine, Shenzhen Second People’s Hospital, 1st Affiliated hospital of Shenzhen University, Shenzhen, 518035, Guangdong Province, China, Kan Ouyang, Daping Wang, Wei Lu, Jian Xu, Liangquan Peng, Haifeng Liu, Hao Li & Wenzhe Feng, Department of Orthopaedics, Shenzhen Second People’s Hospital, 1st Affiliated hospital of Shenzhen University, Shenzhen, Guangdong Province, China, You can also search for this author in Cohen MS. Fractures of the coronoid process. Medial oblique compression fracture of the coronoid process of the ulna. This site needs JavaScript to work properly. Regan and Morrey [6] classified fractures based on the fragment size, with type III fracture accounting for more than 50% of the coronoid process fractures. b Lateral cutaneous nerve of the forearm. A hollow cancellous bone screw of appropriate length and a diameter of 2.0 or 3.5 mm was selected and fixed into the bone, using the wire as a guide (Fig. 2). Isolated type IIIA fracture of the coronoid process of ulna. J Hand Surg Am. According to O’Driscoll’s [13] typing method, two patients were classified as having tip fracture (O’Driscoll type I), and four patients were classified as having anteromedial fracture (O’Driscoll type II). 2004;35(6):631–3. The low incidence of this specific fracture pattern compelled us to study only a small number of cases. The radial head, on the other hand, is a stabilizer to resist valgus stress regardless of the status of the coronoid. Fracture of the coronoid process is not uncommon; it seldomly occurs in isolation and is often accompanied by other fractures or ligament damage in the area, leading to elbow instability. 2019 Jan;27(1):314-318. doi: 10.1007/s00167-018-4926-2. 2003;3(4):199–207. https://0-doi-org.brum.beds.ac.uk/10.1186/s13018-016-0505-8, DOI: https://0-doi-org.brum.beds.ac.uk/10.1186/s13018-016-0505-8. The specimens were randomized to screw fixation or suture lasso fixation. Larger fragments can be fixed by screws as necessary with cannulated or non-cannulated screws. To the editor: On "Optimal screw orientation for fixation of coronoid fractures". Development of the trabecular structure within the ulnar medial coronoid process of young dogs. Terms and Conditions, 2016;25(8):1268–73. However, the types I and II fractures may often be ignored by treatment which makes the outcome more difficult to predict than type III fractures. J Bone Joint Surg Am. Anatomy of the elbow with a median approach using the Kirschner wire. Farr S, Rois J, Ganger R, et al. Since the elbow remained unstable throughout the range of … Moreover, it may hinder the blood supply of the fracture fragments. The combination of small fracture fragment comminution and soft tissue stripping may result in insufficient fixation and residual instability. Knee Surg Sports Traumatol Arthrosc. © 2020 BioMed Central Ltd unless otherwise stated. Manage cookies/Do not sell my data we use in the preference centre. Rausch V, Hackl M, Seybold D, Wegmann K, Müller LP. J Bone Joint Surg Am. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 2003;52:113–34. 2006;31(1):45–52. Shoulder Elbow. J Orthop Surg Res 12, 9 (2017). All fractures were consequences of indirect violence. O’Driscoll [7, 13] and Doornberg and Ring [15] reported that the elbow joint instability may result from a small fracture, such as Regan and Morrey types I and II or O’Driscoll types I and II fractures. Arch Orthop Trauma Surg. [Study advancement of anatomy and biomechanics of posterior three type screw fixation techniques of axial]. J Shoulder Elbow Surg. In patients classified as having Regan and Morrey type II fracture, which is a comparatively larger fracture, two hollow screws were used. J Hand Surg Am. Physical therapy following coronoid fracture fixation is usually surgeon dependent and is variable. Fixation of the coronoid fragment again depends on location and size. Posterolateral rotatory instability of the elbow. All authors read and approved the final manuscript. HHS The mean stiffness was 106 N/mm with PA screws and 76 N/mm with AP screws (P < 0.05). Part of Intra- and postoperative X-ray examination showed that the fractures were satisfactorily fixed and that the screw and fracture line were vertical to each other. The outpatients were regularly reviewed to assess the overall function of their elbow joint, based on the Mayo Elbow Performance Score (MEPS) scoring system [3], considering factors such as pain (45 points), range of motion (20 points), stability (10 points), daily function (25 points), and so on, with ≥90 points scored as A, 75–89 points scored as B, 60–74 points scored as C, and ≤60 points scored as D. X-ray examinations conducted at the time of surgery showed that all fractures were anatomically reduced. The patient was laid in a supine position on the operating table, with the upper limb, the elbow, and the upper limb flexed forward to 90° and the forearm flexed to nearly 30°. 1). The brachial artery and median nerve lie on the inner flank of the biceps tendon, protected by the muscle tendon; the lateral cutaneous nerve to the forearm, cephalic vein, radial nerve, and radial collateral artery are on its outer flank. The anterior area of the elbow is rich in blood vessels and nerves; however, the area that is close to the outer flank of the biceps tendon is relatively safe (Fig. 6). There are several ways to treat the radial head and coronoid fractures; controversy still exists regarding the best way to treat each. 2005;13(7):608–11. The dataset supporting the conclusions of this article is available at our institution. USA.gov. Five patients were followed up for an average of 11 (range, 7–24) months; one patient was lost to follow-up (Table 1). Injury. Pugh DM, Wild LM, Schemitsch EH, et al. Coronoid process fractures of the ulna are difficult to treat, and are associated with stiffness, recurrent instability, and pain. The elbows showed excellent results according to the Mayo Elbow Performance Score. Ouyang, K., Wang, D., Lu, W. et al. Eur J Orthop Surg Traumatol. Even though type I fractures can usually be treated non-surgically, the optimal treatment for type I coronoid process fractures remains controversial [19]. fixation of the coronoid fracture leads to fewer complications and improved outcomes compared with screw or suture anchor fixation techniques. METHODS:This retrospective study analyzed patients with complex elbow fracture-dislocations who underwent surgical fixation for coronoid fractures of the ulna from March 2009 to January 2016. Fractures of the coronoid process of the ulna. In our study, none of the patients got comminuted ulna fractures and were complicated with radial fractures in which arthroplasty, open reduction, or internal fixation of radial fractures were not needed. Follow-ups showed that the fractures had healed well, and the average elbow extension was −2° while the average flexion was 140°. The conclusions of this arthroscopic technique the lateral cutaneous nerve of the status of the coronoid height and. 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