Most coronoid fractures and fracture-dislocations with no radial head involvement can be treated nonsurgically with elbow immobilization

Foruria, Antonio M.; Gutiérrez, Begoña; Cobos, Jesús; Haeni, David; Valencia, María; Calvo, Emílio

doi:10.1016/j.jse.2019.01.005

Cited by 35 publications

(12 citation statements)

References 30 publications

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“…Stress radiography may be used to reveal subtle instability 21 but recently this has been brought into question. 22 In fact an MRI based study 23 showed a 100% associated lateral collateral ligament injury in isolated coronoid fractures, irrespective of the level of fracture and all of these demonstrated instability on fluoroscopy.…”

Section: Imagingmentioning

confidence: 98%

“…Budoff 21 in his review of coronoid fractures states that nonoperative management should be limited to those with a very small fracture fragment and no signs of instability on static or dynamic radiographs. However, Foruria et al 22 argue that dynamic instability is to be expected in all these fractures and recommend that most isolated coronoid fractures can be managed nonsurgically. They have proposed a treatment algorithm which is presented in Fig.…”

Section: Non Operativementioning

confidence: 99%

See 1 more Smart Citation

Proximal ulna fractures in adults: A review of diagnosis and management

Masood

Qulaghassi

Grewal

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Proximal ulna fractures are relatively common upper limb injuries, which may represent fragility fractures or result from high-energy trauma. These include fractures of the olecranon, coronoid and associated radial head dislocations. A wide variety of treatment options are available for the management of these injuries that makes the selection of most appropriate treatment difficult. We aim to provide a brief overview of the treatment options for such injuries.

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Section: Imagingmentioning

confidence: 98%

Section: Non Operativementioning

confidence: 99%

Proximal ulna fractures in adults: A review of diagnosis and management

Masood

Qulaghassi

Grewal

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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“…Based on previous studies, the consensus for conservative treatment of coronoid fracture was that the coronoid process fragment is <5 mm and not easy to fix; otherwise, internal fixation is required 25 . But repairing the MCL and LCL are controversial in the treatment of PMRI.…”

Section: Discussionmentioning

confidence: 99%

Repair Versus Non‐Repair of Lateral Ulnar Collateral Ligament in Elbow Varus Posteromedial Rotatory Instability Treatment: A Comparative Study

Zhang

Jin

et al. 2021

Orthopaedic Surgery

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Objective To compare the effects of repairing and not repairing the lateral ulnar collateral ligament (LUCL) when surgically treating elbow varus posteromedial rotatory instability (PMRI). Methods In this retrospective study spanning June 2014 to February 2019, 24 patients with elbow PMRI who were treated surgically were assigned to group RL (Repair LUCL) or group NL (Non‐repair LUCL) depending on whether the LUCL was repaired. Hospitalization time, operation time, intraoperative blood loss, and related complications were reviewed. The elbow range of motion (ROM), the visual analog scale (VAS), the Mayo elbow performance score (MEPS), and the disabilities of the arm, shoulder, and hand (DASH) score were used for functional assessment. Results Among the 24 patients with PMRI, 15 were assigned to group RL and nine were assigned to group NL. The mean blood loss (184.66 ± 20.3 vs 207.33 ± 19.447, P < 0.001), the operation time (98.88 ± 12.693 min vs 184.66 ± 20.3 min, P < 0.001) were significantly lower in group RL compared to group NL. There were no significant differences between the two groups in time until surgery and follow‐up time (6.66 ± 1.838 vs 6.11 ± 1.900 days, 25.53 ± 2.099 vs 26.11 ± 2.891 months, P = 0.577, P = 0.486). All of the patients achieved bone union. The elbow flexion‐extension ROM (122.00° ± 3.162°vs 121.11° ± 3.333° at 12 months, P = 0.520) and pronation‐supination ROM (154.53° ± 3.335° vs 155.55° ± 4.639° at 12 months, P = 0.537). Both groups achieved similar results in MEPS score (90.53 ± 2.695 vs 89.77 ± 3.865, P = 0.578) and DASH (9.77 ± 1.897 vs 9.99 ± 1.550, P = 0.772) score at the final follow‐up. And the MEPS score revealed excellent results (87% in group RL, 89% in group NL).The VAS scores decreased significantly in group RL (from 6.13 ± 0.990 to 1.93 ± 0.593) and group NL (from 5.77 ± 1.481 to 1.88 ± 0.781), and no significant differences in preoperative or final follow‐up were observed between the two groups (P = 0.487, P = 0.876). Complications observed in group NL with one patient occurred cubital tunnel syndrome 3 months after the operation, the patient underwent ulnar nerve simple neurolysis and the symptoms were relieved after 3 weeks. Conclusion For patients with elbow PMRI, satisfactory functional outcomes can be yielded with non‐repair of the LUCL as long as the stable elbow joint is performed during operation.

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“…Only a few studies are available in the literature with isolated coronoid fractures with or without elbow dislocation. Foruria et al studied 38 consecutive patients sustaining acute isolated coronoid fractures in which 28 were treated nonsurgically and obtained good results in most of the patients [21]. He suggested that an isolated coronoid fracture with a congruent elbow joint, an adequate sublime tubercle, and a fractured coronoid height of less than 50% can be treated nonoperatively.…”

Section: Discussionmentioning

confidence: 99%

Functional Outcome of Surgically Treated Isolated Coronoid Fractures With Elbow Dislocation in Young and Active Patients

Kumar

Sodavarapu

Kumar

et al. 2020

Cureus

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Coronoid fractures are less frequent injuries seen in around one-tenth of patients with elbow dislocation. Any injury to the coronoid process can be associated with elbow instability, in which injury to collateral ligaments co-exists, resulting in a loss of congruency of the elbow joint. However, there is a scarcity of evidence regarding patients' management with elbow dislocation and associated coronoid fractures. So, our aim is to assess the functional outcome of the elbow after operative fixation in patients with any type of coronoid fracture with associated elbow dislocation. A total of six patients with closed coronoid fracture of the elbow, with associated elbow dislocation, without any other associated trauma or previous surgery to the same limb, were included in our study. After closed reduction, patients with an incongruent reduction of the elbow joint were operated. The injured structures were repaired in an inside-out sequence: the coronoid fragment was first reduced by using a lasso-type suture. The larger fragments of the coronoid were fixed with either a screw or a plate when deemed necessary. Then, the lateral collateral ligament was repaired either using a suture anchor or transosseous (No. 2 Arthrex; Naples, Florida) sutures. After repair, the elbow was examined for stability radiologically using the hanging arm test; a concentric reduction of the elbow in lateral view during this test indicates a stable elbow. All patients showed a good to excellent outcome on the Mayo elbow performance score (MEPS) at the final follow-up (three patients had an excellent score while three had a good score). At the final follow-up, mean elbow flexion was 124º, loss of extension was 10º in only one patient, mean supination was 80º, and mean pronation was 72º. Isolated fractures of the coronoid associated with elbow dislocation require appropriate evaluation and management. Closed reduction and immobilization alone in young and active patients may not be sufficient, especially in patients with incongruent ulnohumeral joint. Surgical fixation of the coronoid fragment and repair of the collateral ligament, whenever indicated, can provide good functional outcomes.

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Most coronoid fractures and fracture-dislocations with no radial head involvement can be treated nonsurgically with elbow immobilization

Cited by 35 publications

References 30 publications

Proximal ulna fractures in adults: A review of diagnosis and management

Proximal ulna fractures in adults: A review of diagnosis and management

Repair Versus Non‐Repair of Lateral Ulnar Collateral Ligament in Elbow Varus Posteromedial Rotatory Instability Treatment: A Comparative Study

Functional Outcome of Surgically Treated Isolated Coronoid Fractures With Elbow Dislocation in Young and Active Patients

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