Coronoid Process Fracture
(Redirected from Coronoid Fracture)
Other Names
- Elbow Fracture
- Coronoid Process Fracture
- Anteromedial Coronoid Facet Fracture (AMCF)
Background
- Refers to fracture of the proximal Ulnar, specifically the Coronoid
- Often co-occur with Elbow Dislocation and Radial Head Fracture leading to the so-called Terrible Triad of Elbow
Epidemiology
- Represents 10-15% of elbow injuries[1]
Pathophysiology
- Involve a high energy mechanism from sport, work, MVC
- Can involve twisting and flexion or hyperextension[2]
- High risk of co-occurance with dislocation, which may spontaneously reduce at time of injury
Associated Injuries
- Elbow Dislocation
- Olecranon Fracture
- Posteromedial Rotatory Instability
- Posterolateral Rotatory Instability
- Terrible Triad of Elbow
Risk Factors
- Unknown
Differential Diagnosis
- Fractures
- Adult
- Pediatric
- Dislocations & Instability
- Tendinopathies
- Bursopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Other
- Pediatric Considerations
- Little League Elbow
- Panners Disease (Avascular Necrosis of the Capitellum)
- Nursemaids Elbow (Radial Head Subluxation)
Clinical Features
- General: Physical Exam Forearm
- History
- History of trauma
- Self report elbow pain, swelling, deformity
- Physical
- Bruising, swelling, tenderness
- Loss or range of motion
- Deformity if dislocation present
- Elbow Valgus Stress Test: Evaluate integrity of Ulnar Collateral Ligament
- Elbow Varus Stress Test: Evaluate integrity of Lateral Collateral Ligament Complex
Evaluation
- Radiographs
- Standard 3 views of the elbow
- May be difficult to interpret due to overlapping structures
- Small coronoid fractures easily missed, hard to distinguish from radial head fractures[3]
- CT
- Useful for complex or comminuted fractures
- Helpful for surgical planning
- MRI
- Useful for soft tissue injury evaluation
Classification
Regan and Morrey Classification
- Type I: Coronoid process tip fracture[4]
- Type II: Fracture of 50% or less of height
- Type III: Fracture of more than 50% of height
O'Driscoll Classification
- Subdivides coronoid injuries based on location and number of coronoid fragments
- Recognizes anteromedial facet fractures caused by varus posteromedial rotatory force
Management
- High rate of complications, re-operation
Acute
- Reduce if dislocated under adequate analgesia, often in emergency department
Nonoperative
- Indications
- Type I, II, III with minimal displacement
- Stable elbow
- Immobilization
- Splint: Posterior Long Arm Splint
- For 2-3 weeks then move into pre-fab for early range of motion
- Prolonged immobilization associated with loss of ROM
Operative
- Indications
- Type I, II, III with significant displacement
- Elbow instability
- Posteriomedial rotator instability
- Olecranon fracture-dislocation
- Terrible Triad of Elbow
- Technique
- ORIF
- Hinged external fixation
Return to Play
- Highly variable
- Depending on orthopedic surgeon
Complications
- Elbow contracture/ stiffness
- Nonunion
- Post-traumatic Arthritis
- Elbow instability
- Failure of surgical intervention
See Also
- Internal
- External
- Sports Med Review Elbow Pain: https://www.sportsmedreview.com/by-joint/elbow/
References
- ↑ Morrey BF. The elbow and its disorders. 3rd ed. Philadelphia, PA: W.B. Saunders Company; 2000.
- ↑ Doornberg JN, Ring D. Coronoid fracture patterns. J Hand Surgery [Am] 2006;31:45–52.
- ↑ McGinley JC, Roach N, Hopgood BC, Kozin SH. Nondisplaced elbow fractures: A commonly occurring and difficult diagnosis. Am J Emerg Med 2006;24:560–566.
- ↑ Regan W, Morrey B. Fractures of the coronoid process of the ulna. J Bone Joint Surg Am. 1989;71(9): 1348–54.