Clinical Orthopaedics and Related Research®

, Volume 472, Issue 7, pp 2068–2074

Transverse Coronoid Fracture: When Does It Have to Be Fixed?

  • Robert U. Hartzler
  • Manuel Llusa-Perez
  • Scott P. Steinmann
  • Bernard F. Morrey
  • Joaquin Sanchez-Sotelo
Symposium: Traumatic Elbow Instability and its Sequelae

DOI: 10.1007/s11999-014-3477-1

Cite this article as:
Hartzler, R.U., Llusa-Perez, M., Steinmann, S.P. et al. Clin Orthop Relat Res (2014) 472: 2068. doi:10.1007/s11999-014-3477-1

Abstract

Background

After elbow fracture-dislocation, surgeons confront numerous treatment options in pursuing a stable joint for early motion. The relative contributions of the radial head and coronoid, in combination, to elbow stability have not been defined fully.

Questions/purposes

The purpose of this study was to evaluate the effect of an approximately 50% transverse coronoid fracture and fixation in the setting of an intact or resected radial head on coronal (varus/valgus) and axial (internal and external rotational) laxity in (1) gravity varus stress; and (2) gravity valgus stress models.

Methods

Kinematic data were collected on six fresh-frozen cadaveric upper extremities tested with passive motion throughout the flexion arc under varus and valgus gravity stress with lateral collateral ligaments reconstructed. Testing included coronoid fracture and osteosynthesis with and without a radial head.

Results

In the varus gravity stress model, fixation of the coronoid improved varus stability (fixed: 1.6° [95% confidence interval, 1.0–2.2], fractured: 5.6° [4.2–7.0], p < 0.001) and internal rotational stability (fixed: 1.8° [0.9–2.7], fractured: 5.4° [4.0–6.8], p < 0.001), but radial head fixation did not contribute to varus stability (intact head: 2.7° [1.3–4.1], resected head: 3.8° [2.3–5.3], p = 0.4) or rotational stability (intact: 2.7° [0.9–4.5], resected head: 3.9° [1.5–6.3], p = 0.4). With valgus stress, coronoid fixation improved valgus stability (fixed: 2.1° [1.0–3.1], fractured: 3.8° [1.8–5.8], p < 0.04) and external rotation stability (fixed: 0.8° [0.1–1.5], fractured: 2.1° [0.9–3.4], p < 0.04), but the radial head played a more important role in providing valgus stability (intact: 1.4° [0.8–2.0], resected head: 7.1° [3.5–10.7], p < 0.001).

Conclusions

Fixation of a 50% transverse coronoid fracture improves varus and internal rotatory laxity but is unlikely to meaningfully improve valgus or external rotation laxity. The radial head, on the other hand, is a stabilizer to resist valgus stress regardless of the status of the coronoid.

Clinical Relevance

Determination as to whether it is necessary to fix a coronoid fracture should be based on the stability of the elbow when tested with a varus load. The elbow may potentially be stable with fractures involving less than 50% of the coronoid. Under all circumstances, the radial head should be fixed or replaced to ensure valgus external rotatory stability.

Supplementary material

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Supplementary Fig S1 (DOC 32 KB)
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Supplementary Fig S1A (TIFF 1117 KB)
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Supplementary Fig S1B (TIFF 1113 KB)
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Supplementary Fig S1C (TIFF 1271 KB)
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Supplementary Fig S1D (TIFF 1385 KB)

Copyright information

© The Association of Bone and Joint Surgeons® 2014

Authors and Affiliations

  • Robert U. Hartzler
    • 1
  • Manuel Llusa-Perez
    • 3
  • Scott P. Steinmann
    • 2
  • Bernard F. Morrey
    • 2
  • Joaquin Sanchez-Sotelo
    • 2
  1. 1.San Antonio Orthopaedic GroupSan AntonioUSA
  2. 2.Department of Orthopedic SurgeryMayo Clinic RochesterRochesterUSA
  3. 3.Hospital de Traumatologia Vall de HebronUniversitat de BarcelonaBarcelonaSpain