The Role of the Coronoid Process in Elbow Stability

Closkey, Robert F.; Goode, Joel R.; Kirschenbaum, David; Cody, Ronald P.

doi:10.2106/00004623-200012000-00009

Cited by 236 publications

(116 citation statements)

References 20 publications

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“…However, debate still exists regarding best treatment of these fractures, particularly the treatment of small or very comminuted coronoid fragments. Some published information suggests there might be a role for excision or benign neglect [3,10,17,18], including a recent cadaver study that suggests that in some situations, stability can be maintained without surgical fixation of the coronoid [1]. One must exercise caution when attempting to apply the results of biomechanical studies to the clinical setting, because the complexity and intricacy of injury, coupled in vivo motion, and the stresses across the human elbow, particularly a posttraumatic elbow, in a live subject cannot be completely replicated in the laboratory setting.…”

Section: Discussionmentioning

confidence: 99%

Terrible Triad Injuries of the Elbow: Does the Coronoid Always Need to Be Fixed?

Papatheodorou

Rubright

Heim

et al. 2014

Clinical Orthopaedics &Amp; Related Research

110

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Background The ''terrible triad'' of the elbow is a complex injury that can lead to pain, stiffness, and posttraumatic arthritis if not appropriately treated. The primary goal of surgery for these injuries is to restore stability of the joint sufficient to permit early motion. Although most reports recommend repair and/or replacement of all coronoid and radial head fractures when possible, a recent cadaveric study demonstrated that type II coronoid fractures are stable unless the radial head is removed and not replaced. Questions/purposes The purposes of this study were to determine the (1) range of motion; (2) clinical scores using the Disabilities of the Arm, Shoulder and Hand (DASH) and the Broberg-Morrey questionnaires; and (3) rate of arthritic changes, heterotopic ossification (HO), or elbow instability postoperatively in patients whose terrible triad injuries of the elbow included Reagan-Morrey type I or II coronoid fractures that were treated without fixation. Methods Between April 2008 and December 2010, 14 consecutive patients were treated for acute terrible triad injuries that included two Regan-Morrey type I and 12 Regan-Morrey type II coronoid fractures. Based on the senior author's (DGS) clinical experience that coronoid fractures classified as such do not require fixation to restore intraoperative stability to the posterolaterally dislocated elbow, all injuries were treated by the senior author with a surgical protocol that included radial head repair or prosthetic replacement and repair of the lateral ulnar collateral ligament (LUCL) followed by intraoperative fluoroscopic examination through a range of 20°to 130°of elbow flexion to confirm concentric reduction of the ulnohumeral joint. Using this protocol, intraoperative stability was confirmed in all cases without any attempt at coronoid or anterior capsular repair. Repair of the medial collateral ligament or application of external fixation was not performed in any case. All patients were available for followup at a minimum of 24 months (mean, 41 months; range, 24-56 months). The mean patient age was 52 years (range, 32-58 years). At the followup all patients were evaluated clinically and radiographically by the senior author. Outcome measures included elbow range of motion, forearm rotation, elbow stability, and radiographic evidence of HO or arthritic changes using the Broberg and Morrey scale. Elbow instability was defined as clinical or radiographic evidence of recurrent ulnohumeral dislocation or subluxation at final followup. Clinical outcomes were assessed with the patient-reported DASH questionnaire and the physician-administered Broberg-Morrey elbow rating system. Results The mean arc of ulnohumeral motion at final followup was 123°(range, 75°-140°) and mean forearm Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connectio...

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Section: Discussionmentioning

confidence: 99%

Terrible Triad Injuries of the Elbow: Does the Coronoid Always Need to Be Fixed?

Papatheodorou

Rubright

Heim

et al. 2014

Clinical Orthopaedics &Amp; Related Research

110

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“…Further biomechanical and clinical studies have documented the role of the coronoid process in the stability of the elbow. [2][3][4] There has been a trend towards more operative fixation of more severe fractures. In the original series Regan and Morrey 1 classified these fractures into three types and most of their patients were treated conservatively.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Clinically, Doornberg and Ring 5 highlighted the importance of recognising more complex, but clinically significant types of coronoid fracture and instituting appropriate treatment. In a series of 18 patients, they noted that a poorer result was seen in those who were thought retrospectively to have had inadequate treatment compared with those managed by adequate fixation.…”

mentioning

confidence: 99%

Management and outcome of 103 acute fractures of the coronoid process of the ulna

Adams

Hoskin²,

Morrey

et al. 2009

The Journal of Bone and Joint Surgery. British volume

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“…The coronoid functions as a bony buttress to posterior ulnar displacement. 6 It receives much of the axial load on the elbow between 60 degrees and 105 degrees of flexion. Cadaveric modeling has demonstrated in extension and axial loading that approximately 40% of the load is distributed across the ulno-humeral joint.…”

Section: Anatomy Of the Elbowmentioning

confidence: 99%