An original internal fixation technique by tension band wiring with steel wire in fractures of the coronoid process

Seok

2022

JCM

The ulnar coronoid process plays a key role in maintaining elbow stability; however, there is no gold standard treatment for ulnar coronoid process fractures. We present a novel surgical technique, arthroscopic reduction and bent K-wire fixation, for type II and III coronoid process fractures according to the O’Driscoll classification. Five patients were treated and retrospectively reviewed between January 2016 and December 2019. All the surgeries were performed by a single surgeon. We evaluated clinical outcomes by evaluating a range of motion, disability of arm, shoulder, and hand (DASH) score, Mayo Elbow Performance score (MEPS), and radiographic images. Intraoperative and postoperative radiographs showed that the fractures healed well and were satisfactorily fixed. The average elbow extension/flexion was −3/130, with an average DASH score of 2.42 and MEPS of 97. Coronoid process fractures can be treated successfully with arthroscopic reduction and fixation of bent K-wire, which allows more rigid fixation and early functional exercise, resulting in good outcomes without special tools.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Arthroscopic Reduction and Fixation of Coronoid Fractures with Bending K-Wire: A New Technique

Seok

2022

JCM

“…A report by Han et al [ 6 ] of the outcomes of 11 isolated Regan and Morrey type III fractures treated by an anterior approach showed an average of 21 months of follow-up, overall flexion arc was 127.3°, average flexion was 130.9 degree, and average pronation and supination were 73.2 and 75.9 degree, MEPS of 92.3 points; these values were very similar to ours (Table 1 ). Mallard et al, [ 22 ] however, reported the results of 5 patients with coronoid process fractures treated by tension band wiring with a minimum of a 1.1-year follow-up. The mean flexion–extension arc of elbow motion was 115.0 ± 9.62 degree, pronation was 86.0 ± 1.87 degree, supination was 85.0 ± 4.47 degree, and MEPS was 81.…”

Section: Discussionmentioning

confidence: 99%

Plate fixation through an anterior approach for coronoid process fractures

Feng

Xin²,

Jiang

et al. 2018

Medicine

Coronoid process fractures of the ulna are difficult to treat, and are associated with stiffness, recurrent instability, and pain. Hence, treatment of coronoid process fractures are challenging for surgeons. The purpose of this study was to report the clinical outcomes of an anterior surgical approach associated with plate fixation for Regan and Morrey type II or type III fractures of the coronoid process.We evaluated 16 consecutive patients who underwent surgical treatment for fracture of the coronoid process of the ulna from March 2012 to July 2016. Ten patients had a type II fracture, and 6 patients had a type III fracture. All patients underwent surgical treatment for coronoid process fracture through an anterior approach. While preserving the neurovascular structure, all fractures were treated with buttress plate fixation, maintaining the gap between brachial artery and median nerve. Each patient was treated with concentric reduction of both the ulnotrochlear and the radiocapitellar articulations, without any evidence of elbow instability, except 1 case, who showed some medial instability.At the final follow-up, solid osseous union was confirmed for all coronoid fractures. The average time to radiologic union was 16.3 weeks. The mean flexion–extension arc was 124.25 ± 12.12 degree, with a mean flexion contracture of 8.25 ± 4.36 degree, and further flexion of 132.5 ± 9.31 degree. The mean forearm rotation arc was 167.81 ± 10.49 degree. Fifteen patients achieved a functional arc of motion. The mean Mayo elbow performance score was 92.1 points, with 12 excellent cases and 4 good cases.Coronoid process fractures of the ulna can be treated successfully with plate fixation through an anterior surgical approach, which allows for accurate reduction and rigid internal fixation and early functional exercise, resulting in a reasonable outcome.

BMC Musculoskelet Disord

“…Besides, a recent study indicates that ulna coronoid fractures can be treated by internal fixation with frame shape plate and open reduction through anterior approach of the elbow, as it is an effective treatment option with minimal damage and strong fixation [ 12 ]. It has been previously reported that ulna coronoid fractures treated with internal fixation had better mechanical resistance than suture anchors for fixing small fragments and internal fixation with tension band wiring with steel wire is an excellent approach to treat coronoid fractures [ 13 – 15 ]. Internal fixation with mini plate is effective for early functional exercise as it provides sufficient stability and improves functional outcome [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of internal fixation with mini plate and internal fixation with hollow screw for Regan-Morrey type II and III ulna coronoid fractures

Chen

Gao

2018

BackgroundUlna coronoid fracture is a complicated injury and occurred in the coronal plane. Undeniably, there is no universally accepted approach for treating ulna coronoid fractures. Therefore, this study aimed at exploring the efficacy of different surgical treatments for Regan-Morrey type II and III ulna coronoid fractures.MethodsA total of 164 patients with ulna coronoid fractures were admitted and treated in department of orthopedics at Yiwu Central Hospital, the Affiliated Yiwu Hospital of Wenzhou Medical University for retrospective analysis. The baseline features (age, gender, time from injury to surgery and so on) before the surgery and different conditions during the surgery were compared. Following that, the Visual Analogue Scale (VAS) pain score was employed to evaluate the severity of preoperative and postoperative pain experienced by the patients in each group. Afterwards, Broberg and Morrey elbow score was used to evaluate elbow joint function and surgical effect of the patients. Lastly, the postoperative recovery and complications were compared.ResultsIt was firstly observed that internal fixation with mini plate and hollow screw compelled to lower average operation time and blood loss than Kirschner wire and steel wire suture. Next, the severity of postoperative pain was lessened in comparison with preoperative pain. Afterwards, mini plate and hollow screw improved elbow joint function more notable than Kirschner wire and steel wire suture, and Kirschner wire and steel wire suture resulted in higher incidence of complications and worse postoperative recovery.ConclusionCollectively, this study clarified that for the treatment of Regan-Morrey type II and III ulna coronoid fractures, internal fixation with mini plate and hollow screw has an overall superior surgical effect than internal fixation with Kirschner wire and steel wire suture.