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Coronoid Fracture S52.043A 813.02

Coronoid fracture xray

proximal ulna anatomy

elbow-ligaments

Elbow Cross Sectional Anatomy

Type I Coronoid Fracture

Type II Coronoid Fracture

Type III Coronoid Fracture

Anteromedial Facet Coronoid Fracture

Posteromedial approach to the elbow

Type III coronoid fracture orif

synonyms: coronoid fracture, elbow fracture-dislocation

 

Coronoid Fracture ICD-10

 

Coronoid Fracture ICD-9

  • 813.02(closed fracture of coronoid process of ulna)
  • 813.12(open fracture of coronoid process of ulna)

Coronoid Fracture Etiology / Epidemiology / Natural History

  • Occur in 2-10% of elbow dislocations

Coronoid Fracture Anatomy

Coronoid Fracture Clinical Evaluation

  • Evaluate for tenderness or bruising at the radial and ulnar collateral ligament origins.
  • Evaluate for elbow stability.
  • Document NV exam.
  • Document wrist evaluation.

Coronoid Fracture Xray / Diagnositc Tests

  • A/P, lateral and oblique elbow films indicated. Coronoid fractures are often obscurbed by associated radial head fracture. "River delta sign"=narrowing of the joint space from lateral to medial=indicates coronoid fx or ligamentous instability.
  • Consider stress xrays to determine ligamentous stability. If any concern for instability is present stress radiographs are indicated. Stress xray comparisons to uninjured side are always helpful.
  • CT is best for determining fracture location and comminution and should be considered if the diagnosis is questionable, especially if associated with radial head fracture.

Coronoid Fracture Classification / Treatment

  • Reagan and Morrey (JBJS 71A:1348, 1989) classification based on review of 35 patients. Anteromedial Facet fractures later described by O'Driscoll.
  • Type I, stable (avulsion of the tip of the coronoid process): usually related to posterolateral rotatory elbow subluxation. Treatment = early protected ROM.
  • Type I, unstable or associated radial head fracture. Treatment = ORIF; if fragment is large enough for fixation with a screw or k-wire it should be fixed via the lateral exposure to the radial head. Any collateral ligament injury must be repaired as well.
  • Type II, stable( <50% of coronoid): Treatment = early protected ROM.
  • Type II, unstable or associated radial head fracture. Treatment = ORIF; if fragment is large enough for fixation with a screw or k-wire it should be fixed. Any collateral ligament injury must be repaired as well.
  • Type III (basal coronoid fracture): Treatment = ORIF usually via a posteromedial aproach. Often associated with olecranon fracture/dislocations. Associated injuries should be anatomically repaired as well.
  • Anteromedial Facet Fracture, stable: Occur with varus posteromedial rotation during axial loading. Associated with LCL rupture and are usually unstable. Treatment = ensure joint is stable with stress radiographs, consider EUA. Early protected ROM if joint is confirmed to be stable.
  • Anteromedial facet fracture, unstable: Treatment = ORIF with concomitant LCL/radial head repair usually via a utilitarian posterior exposure with posteromedial coronoid exposure. (Doornberg JN, JBJS 2006;88A:2216).
  • Always consider hinged external fixation for severe injuries where joint stability is a concern post-operatively.

Coronoid Fracture ORIF Technique

  • Note: Coronoid fractures can be fixed via a posteromedial exposure, or from a posterolateral exposure during radial head repair. A utilitarian posterior incision is general used.
  • Pre-operative antibiotics
  • Supine with arm board, tourniquet high on arm, C-arm available
  • Posterior incision from 6cm proximal to olecranon to 6cm distal to olecranon. Curved around medial border of olecranon to avoid painful scar.
  • Medial and lateral skin flaps are raised depending on associated pathology.
  • Ulnar nerve identified and transposed anterior to the medial epicondyle.
  • Flexor carpi ulnaris incised longitudinally, leaving a fascial cuff for later repair. FCU is subperiosteally elevated exposing anterior band of medial collateral ligament and the coronoid.
  • Fracture is repair using AO techniques with k-wires, screws and buttress plate as needed.
  • Irrigate.
  • FCU repaired.
  • Ulnar nerve secured anterior to the medial epicondyle with a fascial sling.
  • Close in layers.
  • Consider the use of a unilateral hinged external fixator placed on the lateral side to counteract varus gravitational stresses.

Coronoid Fracture Associated Injuries / Differential Diagnosis

Coronoid Fracture Complications

  • Instability
  • Stiffness, most will experience some loss of extention.
  • Arthritis
  • Infection
  • Heterotopic ossification

Coronoid Fracture Follow-up Care

  • Bulkly dressing with posterior splint post-operatively
  • 7-10 day post-operative: Splint removed, ROM in a hinged elbow brace is started with ROM determined by security of fixation achieved at surgery.
  • See also Elbow Outcome Measures.

Coronoid Fracture Review References