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Anterior approach for fixation of isolated type III coronoid process fracture

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Abstract

Authors chose anterior approach through the antecubital fossa for better exposure in that case of isolated coronoid process fracture. The objective of the study was to report validity of anterior approach for the Regan and Morrey type III, isolated fracture of the coronoid process of the ulna without residual valgus or varus instability. From January 2007 and January 2010, we evaluated eleven consecutive patients (7 men, 4 women; mean age 44 years; range 25–67 years) who underwent surgical fixation through the anterior approach. The mean follow-up period was 21 months (range 15–34 months). Preoperative and follow-up roentgenograms were evaluated for assessment of the fracture configuration and confirmation of fracture union. Clinical evaluation included an analysis of surgical complication, range of motion, Mayo elbow performance score, and DASH (disability of the arm, shoulder, and hand) score. Fractures were mainly fixed with plate and screws in 8 cases, cannulated screws in 3 cases. There was no residual joint instability after fracture fragment fixation. All fractures were united, and the average union time was 15.2 weeks with a range of 11–20 weeks. Mean flexion contracture of the elbow was 3.6° (range 0°–10°), and further flexion was 130.9° (range 125°–140°) at the last follow-up. Mean Mayo elbow performance score was 92.3 (range 80–100 points), and mean DASH score was 5.9 (range 1.6–8.3 points). In conclusion, Primary fixation of the coronoid process fractures through the anterior approach could be particularly useful in the Regan and Morrey type III isolated coronoid process fractures.

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References

  1. Morrey BF, An KN (2005) Stability of the elbow: osseous constraints. J Shoulder Elbow Surg 14(1):174S–178S. doi:10.1016/j.jse.2004.09.031

    Article  PubMed  Google Scholar 

  2. Morrey BF, An K-N (2009) Functional evalution of the elbow. In: Morrey BF, Sanchez-Sotelo J (eds) The elbow and its disorders. 4th edn. Saunders Elsevier, Philadelphie, pp 80–91

  3. Regan W, Morrey B (1989) Fractures of the coronoid process of the ulna. J Bone Joint Surg Am 71(9):1348–1354

    PubMed  CAS  Google Scholar 

  4. Morrey BF (2000) The elbow and its disorders. In: Morrey BF (ed) Fractures of the proximal ulna and olecranon. W.B. Saunders, Philadelphia, pp 405–428

    Google Scholar 

  5. Kalicke T, Muhr G, Frangen TM (2007) Dislocation of the elbow with fractures of the coronoid process and radial head. Arch Orthop Trauma Surg 127(10):925–931. doi:10.1007/s00402-007-0424-6

    Article  PubMed  Google Scholar 

  6. Patterson SD, Bain GI, Mehta JA (2000) Surgical approaches to the elbow. Clin Orthop Relat Res 370:19–33

    Article  PubMed  Google Scholar 

  7. Adams JE, Hoskin TL, Morrey BF, Steinmann SP (2009) Management and outcome of 103 acute fractures of the coronoid process of the ulna. J Bone Joint Surg Br 91(5):632–635. doi:10.1302/0301-620X.91B5.21755

    Article  PubMed  CAS  Google Scholar 

  8. Jeon IH, Oh CW, Kyung HS, Park BC, Kim PT, Ihn JC (2005) Functional outcome after operative treatment of eight type III coronoid process fractures. J Trauma 59(2):418–423

    Article  PubMed  Google Scholar 

  9. Aksu N (2008) Surgical treatment of elbow dislocations accompanied by coronoid fractures. Acta Orthopaedica et Traumatologica Turcica 42(4):258–264. doi:10.3944/aott.2008.258

    Article  PubMed  Google Scholar 

  10. Vishwanath J, Agarwal A, Mehtani A, Kapoor SK (2002) Isolated type IIIA fracture of the coronoid process of ulna. A case report and brief review of literature. Archi Orthop Trauma Surg 122(3):184–185. doi:10.1007/s00402-001-0353-8

    Article  Google Scholar 

  11. Hanks GA, Kottmeier SA (1990) Isolated fracture of the coronoid process of the ulna: a case report and review of the literature. J Orthop Trauma 4(2):193–196

    Article  PubMed  CAS  Google Scholar 

  12. Selesnick FH, Dolitsky B, Haskell SS (1984) Fracture of the coronoid process requiring open reduction with internal fixation. A case report. J Bone Joint Surg Am 66(8):1304–1306

    PubMed  CAS  Google Scholar 

  13. Ameur NE, Rebouh M, Oberlin C (1999) Anterior transbrachial approach of the coronoid apophysis. Chir Main 18(3):220–225

    PubMed  CAS  Google Scholar 

  14. Kristiansen TK, Ryaby JP, McCabe J, Frey JJ, Roe LR (1997) Accelerated healing of distal radial fractures with the use of specific, low-intensity ultrasound. A multicenter, prospective, randomized, double-blind, placebo-controlled study. J Bone Joint Surg Am 79(7):961–973

    PubMed  CAS  Google Scholar 

  15. Hendrix RW (2002) Fracture Healing. In: Rogers LF (ed) Radiology of skeletal trauma, vol 1. 3rd edn. Churchill Livingstone, Philadelphia, pp 203–230

  16. Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29(6):602–608. doi:10.1002/(SICI)1097-0274(199606)29:6<602:AID-AJIM4>3.0.CO;2-L

    Article  PubMed  CAS  Google Scholar 

  17. Ablove RH, Moy OJ, Howard C, Peimer CA, S’Doia S (2006) Ulnar coronoid process anatomy: possible implications for elbow instability. Clin Orthop Relat Res 449:259–261. doi:10.1097/01.blo.0000218729.59838.bc

    PubMed  Google Scholar 

  18. Josefsson PO, Johnell O, Gentz CF (1984) Long-term sequelae of simple dislocation of the elbow. J Bone Joint Surg Am 66(6):927–930

    PubMed  CAS  Google Scholar 

  19. Mehlhoff TL, Noble PC, Bennett JB, Tullos HS (1988) Simple dislocation of the elbow in the adult. Results after closed treatment. J Bone Joint Surg Am 70(2):244–249

    PubMed  CAS  Google Scholar 

  20. Closkey RF, Goode JR, Kirschenbaum D, Cody RP (2000) The role of the coronoid process in elbow stability. A biomechanical analysis of axial loading. J Bone Joint Surg Am 82-A(12):1749–1753

    PubMed  CAS  Google Scholar 

  21. O’Driscoll SW, Jupiter JB, Cohen MS, Ring D, McKee MD (2003) Difficult elbow fractures: pearls and pitfalls. Instr Course Lect 52:113–134

    PubMed  Google Scholar 

  22. Cage DJ, Abrams RA, Callahan JJ, Botte MJ (1995) Soft tissue attachments of the ulnar coronoid process. An anatomic study with radiographic correlation. Clin Orthop Relat Res (320):154–158

    PubMed  Google Scholar 

  23. Doornberg JN, Ring D (2006) Coronoid fracture patterns. J Hand Surg 31(1):45–52. doi:10.1016/j.jhsa.2005.08.014

    Article  Google Scholar 

  24. McKee MD, Pugh DM, Wild LM, Schemitsch EH, King GJ (2005) Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Surgical technique. J Bone Joint Surg Am 87(Suppl 1):22–32. doi:10.2106/jbjs.d.02933

    PubMed  Google Scholar 

  25. Clarke SE, Lee SY, Raphael JR (2009) Coronoid fixation using suture anchors. Hand (NY) 4(2):156–160. doi:10.1007/s11552-008-9142-y

    Article  Google Scholar 

  26. Ring D, Doornberg JN (2007) Fracture of the anteromedial facet of the coronoid process. Surgical technique. J Bone Joint Surg Am 89(Suppl 2):267–283. doi:10.2106/JBJS.G.00059

    PubMed  Google Scholar 

  27. Cheung EV, Steinmann SP (2009) Surgical approaches to the elbow. J Am Acad Orthop Surg 17(5):325–333

    PubMed  Google Scholar 

  28. Ma JF, Chang SM Brachialis insertion measurement: an anatomic cadaver study for plate fixation of the coronoid process fracture. Clin Anat 24(2):179–182. doi:10.1002/ca.21083

  29. Durig M, Muller W, Ruedi TP, Gauer EF (1979) The operative treatment of elbow dislocation in the adult. J Bone Joint Surg Am 61(2):239–244

    PubMed  CAS  Google Scholar 

  30. Josefsson PO, Gentz CF, Johnell O, Wendeberg B (1987) Surgical versus non-surgical treatment of ligamentous injuries following dislocation of the elbow joint. A prospective randomized study. J Bone Joint Surg Am 69(4):605–608

    PubMed  CAS  Google Scholar 

  31. Josefsson PO, Johnell O, Wendeberg B (1987) Ligamentous injuries in dislocations of the elbow joint. Clin Orthop Relat Res 221:221–225

    PubMed  Google Scholar 

  32. Josefsson PO, Gentz CF, Johnell O, Wendeberg B (1987) Surgical versus nonsurgical treatment of ligamentous injuries following dislocations of the elbow joint. Clin Orthop Relat Res 214:165–169

    PubMed  Google Scholar 

  33. Ellerin BE, Helfet D, Parikh S, Hotchkiss RN, Levin N, Nisce L, Nori D, Moni J (1999) Current therapy in the management of heterotopic ossification of the elbow: a review with case studies. Am J Phys Med Rehabil/Assoc Acad Physiatr 78(3):259–271

    Article  CAS  Google Scholar 

  34. Robinson CG, Polster JM, Reddy CA, Lyons JA, Evans PJ, Lawton JN, Graham TJ, Suh JH (2010) Postoperative single-fraction radiation for prevention of heterotopic ossification of the elbow. Int J Radiat Oncol Biol Phys 77(5):1493–1499. doi:10.1016/j.ijrobp.2009.06.072

    Article  PubMed  Google Scholar 

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Correspondence to Soo-Hong Han.

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Han, SH., Yoon, HK., Rhee, SY. et al. Anterior approach for fixation of isolated type III coronoid process fracture. Eur J Orthop Surg Traumatol 23, 395–405 (2013). https://doi.org/10.1007/s00590-012-1007-y

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  • DOI: https://doi.org/10.1007/s00590-012-1007-y

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