Arthroscopically-assisted fixation of anteromedial coronoid facet fracture and lateral ulnar collateral ligament repair for acute posteromedial rotatory fracture dislocation of the elbow

Abstract

If left untreated, varus posteromedial rotatory injuries of the elbow result in poor functional outcomes. Surgical treatment allows restoration of elbow kinematics, minimizing the chances of chronic varus instability and early onset osteoarthritis. However, large exposures are associated with extensive soft tissue stripping, a high risk of infection, nerve injury, poor visualization of the articular surface and longer recovery. Consequently, there has been renewed interest in the use of elbow arthroscopy to circumvent these problems. Arthroscopic treatment offers the potential advantage of a swift recovery, with instant rehabilitation, less stiffness and swelling than might be expected after open repair. We present the first combined arthroscopic-assisted anteromedial facet coronoid fracture fixation and lateral ulna collateral ligament repair in a varus posteromedial rotatory injury of the elbow.

Anatomic relations of the median nerve to the ulnar insertion of the brachialis muscle: safety issues and implications for medial approaches to the elbow joint

“…This study extended the validity of these results obtained with an arthroscopic setting to open surgery, providing relevant information for surgeons performing procedures close to the ulnar insertion of the brachialis, such as open reduction and internal fixation of coronoid fractures with plates, especially if screws placed in anteroposterior direction are required [1][2][3][4]32], or coronoid replacement with a graft [5][6][7][8].…”

“…In that regard, the elbow has a special situation, as three major nerves pass the joint and regularly have to be identified and protected. Fixation of coronoid fractures is known to be a challenging procedure [1][2][3][4], as well as graftreplacement of the coronoid [5][6][7][8]. To address such pathologies, the Hotchkiss and flexor carpi ulnaris (FCU) splitting approaches are commonly used, besides other approaches to the medial elbow [9][10][11][12][13][14][15][16][17].…”

Advances and future trends in elbow arthroscopy

“…The technique and indications for arthroscopic treatment of coronoid fractures are evolving. [66][67][68][69][70][71] Coronoid fractures are usually part of a complex injury pattern. It is important to understand these patterns and the associated injuries that often need to be addressed.…”

“…[101] The LUCL can also be repaired as part of terrible triad injuries and posteromedial rotatory instability injuries. [70,72,102] Arthroscopy is also of value in assessing chronic instability such as posterolateral rotatory instability (PLRI). In lower grade PLRI, LUCL plication has had promising results.…”

Arthroscopic Fixation of Coronoid Fractures: Retrograde Wire Technique

“…There are several potential advantages to an arthroscopic approach to coronoid fractures [3][4][5][6]. Arthroscopic fixation avoids an extensile approach and the fracture can be better visualized.…”