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Coronoid Process Fracture

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Other Names

  • Elbow Fracture
  • Coronoid Process Fracture
  • Anteromedial Coronoid Facet Fracture (AMCF)

Background

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


Risk Factors

  • Unknown

Differential Diagnosis


Clinical Features


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


References


  1. Morrey BF. The elbow and its disorders. 3rd ed. Philadelphia, PA: W.B. Saunders Company; 2000.
  2. Doornberg JN, Ring D. Coronoid fracture patterns. J Hand Surgery [Am] 2006;31:45–52.
  3. 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.
  4. Regan W, Morrey B. Fractures of the coronoid process of the ulna. J Bone Joint Surg Am. 1989;71(9): 1348–54.
Created by:
John Kiel on 25 November 2019 01:22:32
Authors:
Last edited:
11 November 2020 14:29:17
Categories:
Trauma | Elbow | Upper Extremity | Fractures | Acute