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Coronoid tip fractures in terrible triad injuries can be safely treated without fixation

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The optimal treatment of terrible triad injuries of the elbow (TTI) remains topic of ongoing discussion. The aim of this study was to determine whether different treatment strategies for coronoid tip fractures in terrible triad injuries influences the clinical and radiological results in a mid-term follow-up.

Methods

A total of 62 patients with surgical treatment of a TTI including a coronoid tip fracture (37 women, 25 men; mean age, 51 years) were available for follow-up assessment after an average of 4.2 years (range 24–110 months). Thirteen patients had O’Driscoll 1.1 and 49 O’Driscoll 1.2 coronoid fractures, of which 26 were treated with and 36 without fixation. Range of motion, the Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and Disabilities of the Arm, Shoulder and Hand (DASH) score as well as grip strength were evaluated. Radiographs were analyzed for all participants.

Results

No significant benefit in outcome variables could be detected between patients, whose coronoid had been fixed, compared to patients without fixation of the coronoid. In the coronoid fixation group, patients had mean outcome scores of 81.5 ± SD 19.1 (range 35–100) for MEPS, 31.0 ± SD 12.5 (range 11–48) for OES and 27.7 ± SD 23 (range 0–61) for DASH score, while in the no-fixation group, mean MEPS was 90.8 ± SD 16.5 (range 40–100), mean OES was 39.0 ± SD 10.4 (range 16–48) and mean DASH score was 14.5 ± SD 19.9 (range 0–48). Mean range of motion was 116° ± SD 21° (range 85–140°) versus 124° ± SD 24° (range 80–150°) in extension-flexion and 158° ± SD 23° (range 70–180°) versus 165° ± SD 12° (range 85–180°) in pronation-supination. Overall complication rate was 43.5% and revision rate was 24.2%, with no significant differences between both groups. Suboptimal results were more frequently seen in patients who had degenerative or heterotopic changes on their latest radiograph.

Conclusions

Sufficient elbow stability and good outcomes can be achieved in most patients with TTI and coronoid tip fractures. Although some bias in treatment allocation and group heterogeneity cannot be completely omitted, our analysis detected no significant benefit in outcome when the coronoid tip fracture has been fixed compared to patients with non-fixed coronoid tip. Therefore, we would suggest a no-fixation approach for coronoid tip fractures as primary treatment in TTI of the elbow.

Level of evidence

Level III, retrospective comparative study.

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Data availability

Due to the sensitive nature of the data in this study, survey respondents were assured raw data would remain confidential and would not be shared.

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Authors and Affiliations

  1. Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstrasse 430, 60389, Frankfurt, Germany

    Alexander Klug, Angela Nagy, Paul Hagebusch, Sebastian Fischer, Yves Gramlich & Reinhard Hoffmann

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  1. Alexander Klug
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  2. Angela Nagy
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  3. Paul Hagebusch
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Contributions

AK: conception and design, acquisition, examining patients, analysis and interpretation of data, writing the manuscript, statistical analysis, critically revising the article. AN: examining the patients, data analysis, reviewed submitted version of manuscript. sf: proofreading the manuscript, statistical analysis, data analysis. PH: proofreading the manuscript, data analysis, statistical analysis, data analysis. YG: proofreading the manuscript, conception and design, data analysis, administrative/technical/material support. RH: proofreading the manuscript, conception and design, data analysis, administrative/technical/material support.

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Correspondence to Alexander Klug.

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Conflict of interest

None of the authors, their immediate families, nor any research foundation with which they are affiliated, received any financial payments or other benefits from any commercial entity related to the subject of this article.

Ethical approval

The study has been approved by the Ethical Committee of the Regional Medical board of Hessen, Germany (under study ID FF92/2018).

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All investigations were conducted in conformity with the principles of good clinical practice and the ethical principles of research based on the 1964 Declaration of Helsinki, and informed consent for participation in the study was obtained.

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Klug, A., Nagy, A., Hagebusch, P. et al. Coronoid tip fractures in terrible triad injuries can be safely treated without fixation. Arch Orthop Trauma Surg 143, 5055–5064 (2023). https://doi.org/10.1007/s00402-023-04889-9

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