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Rider S, Caldwell C, Chauvin B, Barton RS, Perry K, Solitro GF. Biomechanical evaluation of the modified lasso technique. Orthop Traumatol Surg Res 2025; 111:103900. [PMID: 38703888 DOI: 10.1016/j.otsr.2024.103900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/11/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The Terrible Triad of the elbow is a constellation of elbow dislocation, radial head fracture and coronoid process fracture. A common type of coronoid fracture documented with this triad is type II Regan-Morrey coronoid fractures. The preferred fixation method for this fracture type is the lasso technique, medial-lateral tunnel orientation being the traditional approach. Considering elbow anatomy, we saw an opportunity to potentially improve fixation by altering the suture lasso tunnel orientation to a proximal-distal orientation. HYPOTHESIS Two tunnels in the proximal-distal direction would result in greater biomechanical stability as compared to the traditional lasso technique. MATERIAL AND METHODS A type 2 Regan-Morrey fracture was created in 12 fresh frozen cadaveric elbows at 50% of the coronoid height using an oscillating saw. The humero-ulnar joint was placed in 0 degrees flexion then loaded at a rate of 10mm/min to failure. RESULTS The control technique (medio-lateral tunnels) showed failure load of 150±81N that was not significantly different (p=0.825) than the 134±116N measured for the modified technique (distal-proximal tunnels). The portion of the load-displacement curve used to calculate stiffness was linear (R^2=0.94±0.04) with determination coefficients that did not differ between the two groups (p=0.351). For stiffness, we measured 17±13N/mm and 14±12N/mm respectively for control and modified techniques that did not result in a significant difference (p=0.674). CONCLUSION In this attempt to improve the shortcomings of the lasso technique, we found that changing from medio-lateral to proximal-distal drilling directions did not result in an appreciable biomechanical benefit. LEVEL OF EVIDENCE Basic science study; Biomechanics.
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Affiliation(s)
- Shelby Rider
- Biomechanical Laboratory, Department of Orthopaedic Surgery, Louisiana State University Health, 1501 Kings Hwy, Shreveport, LA 71103, United States
| | - Christopher Caldwell
- Biomechanical Laboratory, Department of Orthopaedic Surgery, Louisiana State University Health, 1501 Kings Hwy, Shreveport, LA 71103, United States
| | - Brad Chauvin
- Biomechanical Laboratory, Department of Orthopaedic Surgery, Louisiana State University Health, 1501 Kings Hwy, Shreveport, LA 71103, United States
| | - R Shane Barton
- Biomechanical Laboratory, Department of Orthopaedic Surgery, Louisiana State University Health, 1501 Kings Hwy, Shreveport, LA 71103, United States
| | - Kevin Perry
- Biomechanical Laboratory, Department of Orthopaedic Surgery, Louisiana State University Health, 1501 Kings Hwy, Shreveport, LA 71103, United States
| | - Giovanni Francesco Solitro
- Biomechanical Laboratory, Department of Orthopaedic Surgery, Louisiana State University Health, 1501 Kings Hwy, Shreveport, LA 71103, United States.
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Sun W, Jiang X, Zha Y, Gong M, Chen C, Hua K, Lu S. Three-dimensional quantitative study and functional outcome analysis of coronoid fracture in different elbow injury patterns. J Shoulder Elbow Surg 2025; 34:104-113. [PMID: 39103084 DOI: 10.1016/j.jse.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/07/2024] [Accepted: 06/09/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Coronoid fractures are often part of a complex fracture-dislocation of the elbow. For an optimum prognosis, it is important to understand the characteristics of coronoid fractures in different elbow injury patterns. Significant differences in these characteristics have been observed in various studies, but these previous studies have suffered from limitations, such as insufficient quantification and unknown prognostic differences among different injury patterns. Therefore, we aimed to quantitatively analyze coronoid fracture characteristics and functional outcomes in different elbow injury patterns using three-dimensional computed tomography. METHODS All patients with coronoid fractures surgically treated at our hospital between January and December 2017 were categorized into 3 groups according to elbow injury pattern: posterolateral rotational instability (PLRI), varus posteromedial rotational instability (VPMRI), and olecranon fracture-dislocation (OFD). 3D models were reconstructed using Mimics 17.0, and the total volume and number of coronoid fragments were measured. The coronoid process edge was classified into different anatomical regions, and each region was assigned a number to quantify the distribution of fracture lines. At the last follow-up, the range of motion, visual analog scale, Mayo Elbow Performance Score, complications and reoperations were recorded. RESULTS The 92 patients enrolled had an average age of 42 ± 15 years and a male-to-female ratio of 66:26. The median total volume in PLRI patients was less than that in VPMRI patients [431 (132, 818) mm3 vs. 1125 (746, 1421) mm3, adjusted P < .001] and OFD patients [431 (132, 818) mm3 vs. 2565 (381, 4076) mm3, adjusted P = .001]. The median number of coronoid fragments in PLRI patients was also less than that in VPMRI patients [1 (1, 2) vs. 2 (1, 3), adjusted P = .043]. Most of the PCFL-Rs (79%) were located around the volar edge of the lesser sigmoid notch. Compared with that of PLRI, the PCFL-Us of the VPMRI and OFD tended to be located on the more ulnodorsal side of the coronoid process edge. The median ROM [110 (90, 133), P = .001] and the median Mayo Elbow Performance Score [85 (68, 95), P = .038] of patients with OFD were significantly less than those of patients with the other 2 patterns. The incidence of elbow stiffness (56%, 5/9, P = .001) and implant-related irritation (44%, 4/9, P < .001) in the OFD group was significantly higher than that in the other 2 groups. CONCLUSION Coronoid fractures differ significantly in fragment volume, comminution severity, and fracture line distribution among different elbow injury patterns. OFD has the worst functional outcomes among complex elbow injury patterns.
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Affiliation(s)
- Weitong Sun
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xieyuan Jiang
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
| | - Yejun Zha
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Maoqi Gong
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Chen Chen
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Kehan Hua
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Shuai Lu
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
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Ormiston R, Hargreaves D. 'The treatable triad' long-term functional results of surgically treated acute isolated terrible triad injuries: an 18-year follow-up. J Shoulder Elbow Surg 2025; 34:114-121. [PMID: 39142433 DOI: 10.1016/j.jse.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Surgical techniques for terrible triad injuries developed 20 years ago. Good and excellent short- and medium-term functional results have been reported. No long-term (over 10 years) functional outcomes have previously been reported. This case-series is the longest follow-up of patients treated for acute isolated terrible triad injuries using a standard treatment protocol. METHODS Twenty patients with acute, isolated, surgically managed terrible triad injuries were treated between October 2001 and May 2008. Ten of these patients were seen face-to face for a clinical follow-up and if required a radiological assessment. Mayo Elbow Performance Scores (MEPSs) and Disabilities of the Arm, Shoulder and Hand (DASH) scores, requirement for further surgery and elbow instability were recorded. RESULTS The average length of follow-up was 18.8 years. The mean Mayo Elbow Performance Score was 88 and the mean Disability of the Arm, Shoulder and Hand score was 12.3. The average loss of pronation was 8°. The average loss of supination was 13°. The reoperation rate was 40%, only one of these was a functionally limiting operation. A trend toward osteoarthritis was observed but there were no conversions to total elbow replacement. DISCUSSION This is the longest-term follow-up study of these injuries and demonstrates the functional performance that the majority of patients achieve. The low follow-up rate can be expected with such a long interval between treatment and assessment. A relatively high reoperation rate is largely made up of minor procedures (removal of metalwork and cubital tunnel release) which did not impact the patients' functional status. This study adds to the evidence that the terrible triad of the elbow is surgically treatable to allow a high functional standard not only in the short-term but also in the long term. As such this is a useful adjunct to have both when informing patients of what can be expected in their long-term recovery from this injury.
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Affiliation(s)
- Rory Ormiston
- Department of Orthopaedics, University Hospital Southampton, Southampton, UK.
| | - David Hargreaves
- Department of Orthopaedics, University Hospital Southampton, Southampton, UK
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Ye H, Yang Y, Xing T, Tan G, Jin S, Zhao Z, Zhang W, Li Y, Zhang L, Wang J, Zheng R, Lu Y, Wu L. Anatomical and Biomechanical Stability of Single/Double Screw-Cancellous Bone Fixations of Regan-Morry Type III Ulnar Coronoid Fractures in Adults: CT Measurement and Finite Element Analysis. Orthop Surg 2023; 15:1072-1084. [PMID: 36647280 PMCID: PMC10102310 DOI: 10.1111/os.13664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE At present, it is still uncertain whether single screw has the same stability as double screws in the treatment of ulnar coronal process basal fracture (Regan-Morry type III). So, we aimed to compare the pull-out force and anti-rotation torque of anterior single/double screw-cancellous bone fixation (aSSBF, aDSBF) in this fracture, and further study the influencing factors on anatomical and biomechanical stability of smart screw internal fixations. METHODS A total of 63 adult volunteers with no history of elbow injury underwent elbow CT scanning with associated three-dimensional reconstruction that enabled the measurements of bone density and fixed length of the proximal ulna and coronoid. The models of coronal process basal fracture, aSSBF and aDSBF, were developed and validated. Using the finite element model test, the sensitivity analysis of pull-out force and rotational torque was carried out. RESULTS The pull-out force of aSSBF model was positively correlated with the density of the cancellous bone and linearly related to the fixed depth of the screw. The load pattern of pull-out force of aDSBF model was similar to that of aSSBF model. The ultimate torque of aDSBF model was higher than that of aSSBF model, but the load pattern of ultimate torque of both models was similar to each other when the fracture reset was satisfactory, and the screw nut attaches closely to coronoid process. Moreover, with enhancement of initial pre-tightening force, the increase of ultimate torque of both models was small. CONCLUSIONS In addition to three pull-out stability factors of smart screw fixations, fracture surface fitting degree and nut fitting degree are the other two important anatomical and biomechanical stability factors of smart screw fixations both for rotational stability. When all pull-out stability and rotational stability factors meet reasonable conditions simultaneously, single or double screw fixation methods are stable for the treatments of ulnar coronoid basal fractures.
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Affiliation(s)
- Hao Ye
- Institute of Digitized Medicine and Intelligent TechnologyWenzhou Medical UniversityWenzhouChina
| | - Yongchao Yang
- Department of OrthopedicsTianjin Teda HospitalTianjinChina
| | - Tingyang Xing
- Institute of Digitized Medicine and Intelligent TechnologyWenzhou Medical UniversityWenzhouChina
| | - Guirong Tan
- Institute of Digitized Medicine and Intelligent TechnologyWenzhou Medical UniversityWenzhouChina
| | - Shuxun Jin
- Institute of Digitized Medicine and Intelligent TechnologyWenzhou Medical UniversityWenzhouChina
| | - Zhichao Zhao
- Institute of Digitized Medicine and Intelligent TechnologyWenzhou Medical UniversityWenzhouChina
| | - Weikang Zhang
- Institute of Digitized Medicine and Intelligent TechnologyWenzhou Medical UniversityWenzhouChina
| | - Yanyan Li
- Institute of Digitized Medicine and Intelligent TechnologyWenzhou Medical UniversityWenzhouChina
| | - Lei Zhang
- Department of Orthopedics, The Third Affiliated HospitalWenzhou Medical UniversityWenzhouChina
| | - Jianshun Wang
- Department of Orthopedics, The Second Affiliated HospitalWenzhou Medical UniversityWenzhouChina
| | - Rongmei Zheng
- Institute of Digitized Medicine and Intelligent TechnologyWenzhou Medical UniversityWenzhouChina
| | - Yun Lu
- Department of OrthopedicsTianjin Teda HospitalTianjinChina
| | - Lijun Wu
- Institute of Digitized Medicine and Intelligent TechnologyWenzhou Medical UniversityWenzhouChina
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Lone AH, Hamid MA, Geelani ZA, Naseer Y. Coronoid fixation and lateral collateral ligament repair in varus posteromedial rotatory instability of the elbow. J Clin Orthop Trauma 2023; 37:102107. [PMID: 36879988 PMCID: PMC9984882 DOI: 10.1016/j.jcot.2023.102107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 12/10/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Background Varus posteromedial rotatory instability is a relatively rare elbow injury, that has been infrequently reported in published literature. We intended to evaluate the outcomes of surgical management of this rare injury with anteromedial coronoid fixation, and, in selected patients, lateral ulnar collateral ligament (LUCL) repair. Methods Between 2017 and 2020, we identified 12 patients with anteromedial coronoid fractures, and a varus posteromedial rotatory instability, who underwent surgery for fixation of the coronoid fracture, with or without LCL repair. All the included patients were either O'Driscoll subtype 2-2, or subtype 2-3. All the 12 patients were followed up for a minimum of 24 months, and their functional outcomes assessed using the Mayo Elbow Performance Score (MEPS). Results The mean MEPS recorded in our study was 92.08, and the mean range of elbow flexion achieved was 124.2°. The mean flexion contracture in our patients was 5.83°. Three of our twelve patients (25%) suffered from elbow stiffness even at final follow-up. The results were graded as Excellent in eight, Good in three, and Fair in one patient. Conclusion Coronoid fractures and LUCL disruptions associated with varus posteromedial rotatory instability can be reliably managed by employing a protocol that combines radiographic parameters, as well as intra-operative assessments of stability. While surgical intervention successfully restored stability, there is a learning curve to the management of these injuries and complications are not uncommon, particularly elbow stiffness. Hence, in addition to surgical fixation, emphasis should also be placed on intensive post-operative rehabilitation to improve outcomes.
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Affiliation(s)
- Ansarul Haq Lone
- Orthopaedic Surgery, Government Hospital for Bone & Joint Surgery, Srinagar, Jammu & Kashmir, India
| | - Muhammad A. Hamid
- Orthopaedic Surgery, Government Hospital for Bone & Joint Surgery, Srinagar, Jammu & Kashmir, India
| | - Zubair A. Geelani
- Orthopaedic Surgery, Government Hospital for Bone & Joint Surgery, Srinagar, Jammu & Kashmir, India
| | - Yawar Naseer
- Orthopaedic Surgery, Government Hospital for Bone & Joint Surgery, Srinagar, Jammu & Kashmir, India
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Jo SW, Shin DJ. The Novel Hooked Kirschner Wire Technique for Ulna Coronoid Process Fractures. Clin Orthop Surg 2023; 15:127-134. [PMID: 36778994 PMCID: PMC9880501 DOI: 10.4055/cios22148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/05/2022] Open
Abstract
Background The aim of this study was to introduce a novel technique to improve the ease of fixing of even small fragments of the coronoid process and report the clinical outcomes of this method. Methods Forty-nine patients with ulnar coronoid process fractures fixed using the hooked Kirschner wire (K-wire) technique at our hospital from 2007 to 2019 were reviewed. Radiological features and fracture union were assessed using simple radiographs. Functional outcomes of the treated elbows were evaluated at the final follow-up visit using the Mayo Elbow Performance Score (MEPS). Results All patients were examined at a mean follow-up of 17.7 months (range, 6-62 months). We observed bony union in patients at a mean of 10.9 weeks (range, 6-22 weeks). The mean flexion and extension ranges of the elbow were 132.0° (range, 106° -151°) and 4.5° (range, -20° to 30°), respectively. The mean pronation and supination ranges of the forearm were 81.1° (range, 60°-90°) and 88.3° (range, 60°-120°), respectively. The mean arc of the elbow was 127.4° (range, 78°-160°). All patients were evaluated using the MEPS at the final follow-up visit, with a mean score of 96.9 points (range, 80-100 points). One case of coronoid nonunion was observed and re-fixation was performed. One case of infection was observed and also treated with additional surgery. Three patients complained of ulnar nerve symptoms and 1 patient underwent surgical release for tardy ulnar nerve palsy. Conclusions Despite its limitations, the hooked K-wire technique was a useful method for even smaller coronoid process fractures. K-wires were also a useful temporary intraoperative fixation method and could provide permanent fixation.
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Affiliation(s)
- Seong-Woo Jo
- Department of Orthopedic Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Dong-Ju Shin
- Department of Orthopedic Surgery, Daegu Fatima Hospital, Daegu, Korea
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A new attempt to treat coronal plane fractures of the elbow joint with salvage via an anterior approach. BMC Surg 2022; 22:257. [PMID: 35787287 PMCID: PMC9254630 DOI: 10.1186/s12893-022-01706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Existing approaches for treating elbow fractures include lateral, medial, anterior and posterior approaches, though the anterior approach is often not chosen by surgeons to avoid damage to important nerves and blood vessels. However, the anterior approach has unique advantages. The purpose of this study was to report outcomes of 38 patients with coronal plane elbow fractures treated through the anterior approach. Methods We retrospectively analyzed 38 cases of coronal plane elbow fracture treated through an anterior approach at our institution between March 2015 and July 2019. The length of the surgical incision, operation time, and postoperative complications were recorded. The range of flexion, extension, and rotation of the affected elbow and the healthy elbow were collected at follow-up. Functional outcomes were evaluated using the Mayo Elbow Function Score (MEPS). Results All 38 patients were followed up for a mean of 21.26 months (range 12–36 months). Intraoperatively, the mean surgical incision length was 8 ± 2 cm and the mean operative time was 123 ± 59 min. At the final follow-up, solid osseous union was confirmed for all coronal plane elbow fractures. The mean elbow flexion arc was 129 ± 7°, and the extension arc was 9 ± 6°. The mean pronation arc was 83 ± 3°, and the supination arc was 80 ± 3°. The mean MEPS was 90 ± 8 points, with 18 excellent cases and 20 cases of excellent and good results, respectively. In 31 cases, there was no significant difference in elbow extension, flexion, or pronation between the single-fracture and healthy elbows (P > 0.05), though the arc of supination was slightly worse than that of the healthy elbow (P < 0.05). VAS pain scores before the operation, at three months after the operation, and during follow-up were compared, and pain was significantly reduced after treatment (P < 0.05). Two patients experienced transient postoperative median nerve paralysis, from which they recovered within three months. One patient had mild heterotopic ossification and was not treated because it did not affect the function of the elbow joint. All patients returned to work and were satisfied with the treatment. Conclusion The anterior approach has the benefits of simplicity, safety, minimal invasiveness, excellent exposure, and satisfactory prognosis for coronal plane elbow fracture.
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Lee HD, Jung YJ, Oh JK, Moon JG. Morphological characteristics of fractures of the anteromedial facet of the coronoid in posteromedial rotatory instability of the elbow: a three-dimensional CT remodeling study. J Shoulder Elbow Surg 2021; 30:1527-1536. [PMID: 33157240 DOI: 10.1016/j.jse.2020.09.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/17/2020] [Accepted: 09/29/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fractures of the anteromedial facet of the coronoid in posteromedial rotatory instability of the elbow are classified into 3 subtypes based on their location. The purpose of this study was to analyze the fracture morphology of anteromedial facet fractures in their 3 subtypes (anteromedial rim, anteromedial rim + tip, and anteromedial rim + sublime tubercle [±tip]). METHODS Three-dimensional computed tomography remodeling was used to evaluate anteromedial facet fractures in a consecutive series of 40 patients, all of whom were affected by posteromedial rotatory instability of the elbow. Characteristics of the fractures, including the number of fragments, size of fragments, plane of the fracture line, and involvement of the sublime tubercle and radial notch, were measured for each subtype of the anteromedial facet fractures. RESULTS Each subtype had a typical fracture pattern and distinct size. The fracture subtype 1 showed a single-fragment fracture, subtype 2 showed either a single- or dual-fragment fracture, and subtype 3 showed either a dual- or triple-fragment fracture. The angle between the fracture line and the coronal plane was greatest in subtype 3 fractures. The surface area of the fragment was largest in subtype 3 fractures. The percentages of articular involvement of the sublime tubercle were 0% in subtype 1, 47% in subtype 2, and 79% in subtype 3. The percentages of articular involvement of the radial notch were 0% in subtype 1, 7% in subtype 2, and 8% in subtype 3. CONCLUSION Analysis with quantitative 3-dimensional computed tomography showed the characteristic morphology of each subtype of anteromedial facet fracture. Subtype 1 comprised 1 fragment with the smallest fragment size. Subtype 2 was a single- or dual-fragment fracture, the size of which should be considered in the treatment plan. Subtype 3 was a large fragment comprising the sublime tubercle. Our findings are significant because they highlight unique fracture morphology that may help surgeons to distinguish one fracture subtype from another in clinical practice.
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Affiliation(s)
- Hee-Dong Lee
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Guro-gu, Seoul, Republic of Korea
| | - Young-Jin Jung
- Department of Orthopaedic Surgery, Cheongra Barun Orthopaedic Center, Incheon, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Guro-gu, Seoul, Republic of Korea
| | - Jun-Gyu Moon
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Guro-gu, Seoul, Republic of Korea.
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Masood QM, Qulaghassi M, Grewal U, Bawale R, Kammela M, Singh B. Proximal ulna fractures in adults: A review of diagnosis and management. J Clin Orthop Trauma 2021; 20:101481. [PMID: 34211834 PMCID: PMC8240031 DOI: 10.1016/j.jcot.2021.101481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022] Open
Abstract
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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Affiliation(s)
| | - Mahdi Qulaghassi
- Medway NHS Foundation Trust, Windmill Road, Gillingham, ME7 5, NY, UK
| | - Urpinder Grewal
- Frimley Park Hospital NHS Foundation Trust, Portsmouth Rd, Frimley, GU16 7UJ, UK
| | - Rajesh Bawale
- Medway NHS Foundation Trust, Windmill Road, Gillingham, ME7 5, NY, UK
| | - Madhavi Kammela
- Medway NHS Foundation Trust, Windmill Road, Gillingham, ME7 5, NY, UK
| | - Bijayendra Singh
- Medway NHS Foundation Trust, Windmill Road, Gillingham, ME7 5, NY, UK
- Corresponding author.
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Yamaura K, Inui A, Mifune Y, Nishimoto H, Kataoka T, Kurosawa T, Mukohara S, Yoshikawa T, Niikura T, Kokubu T, Kuroda R. Anterior transolecranon fracture dislocation with an associated avulsion fracture of coronoid process of ulna in a child: a case report. JSES Int 2020; 5:9-12. [PMID: 33554156 PMCID: PMC7846680 DOI: 10.1016/j.jseint.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Kohei Yamaura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Corresponding author: Kohei Yamaura, MD, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hanako Nishimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Kataoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Kurosawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shintaro Mukohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoya Yoshikawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Kokubu
- Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Lor KKH, Toon DH, Wee ATH. Buttress plate fixation of coronoid process fractures via a medial approach. Chin J Traumatol 2019; 22:255-260. [PMID: 31492574 PMCID: PMC6823711 DOI: 10.1016/j.cjtee.2019.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/30/2019] [Accepted: 07/31/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To assess the clinical and radiographic outcomes of coronoid process fractures surgically managed with buttress plate fixation via a medial approach. METHODS A retrospective review of all coronoid fractures surgically fixed in our institution using a buttress plate technique via a medial approach between June 2012 and April 2015 by the senior author was performed. These fractures were all sizeable fractures contributing to persistent elbow instability in terrible triad or varus posteromedial rotatory instability injury patterns. A prospective telephone questionnaire was conducted to assess patient outcomes using the disabilities of the arm, shoulder and hand (DASH) score and Mayo hlbow performance score (MEPS). RESULTS Twelve patients were included in the study, comprising 10 males and 2 females with an average age of 39 years (range, 19-72 years). Mean follow-up was 16 months (range, 4-18 months). The average time to radiographic union was 4 months (range, 3-7 months). Range of motion measurements at final follow-up were obtained in 11 out of 12 patients, with one patient defaulting follow-up. All 11 patients displayed a functional elbow range of motion of at least 30°-130°, with an average arc of motion of 130° (range, 110° -140°), mean elbow flexion of 134° (range, 110° -140°) and mean flexion contracture of 3° (range, 0° -20°). The mean DASH score was 16 (range, 2.5-43.8) and the mean MEPS was 75 (range, 65-100). Complications observed included one patient with a superficial wound infection which resolved with a course of oral antibiotics and one patient with radiographic evidence of heterotopic ossification which was conservatively managed. No residual elbow instability was observed and no reoperations were performed. CONCLUSION Buttress plate fixation via a medial approach of coronoid process fractures that contribute to persistent elbow instability represents a reliable method of treatment that produces satisfactory and predictable outcomes.
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Affiliation(s)
- Kelvin Kah Ho Lor
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore,Corresponding author.
| | - Dong Hao Toon
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
| | - Andy Teck Huat Wee
- Pinnacle Orthopaedic and Sports Centre, Pinnacle Orthopaedic Group, Singapore
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12
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Foruria AM, Gutiérrez B, Cobos J, Haeni DL, Valencia M, Calvo E. Most coronoid fractures and fracture-dislocations with no radial head involvement can be treated nonsurgically with elbow immobilization. J Shoulder Elbow Surg 2019; 28:1395-1405. [PMID: 30956143 DOI: 10.1016/j.jse.2019.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 12/19/2018] [Accepted: 01/06/2019] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Conservative treatment of isolated coronoid fractures and fracture-dislocations focused on soft-tissue healing can provide good clinical results in the majority of patients. Our aims were (1) to evaluate the outcome of a conservative treatment protocol designed for isolated coronoid fractures with or without associated elbow dislocations (ICFs) and (2) to characterize the fractures with a dedicated image analysis protocol. METHODS Of 38 consecutive patients sustaining acute ICFs, 28 were treated nonsurgically after meeting specific inclusion criteria, prospectively followed up, and clinically evaluated at least 1 year after sustaining their injuries. All cases underwent elbow computed tomography scans with tri-plane and 3-dimensional reconstructions according to a specific protocol referenced to the proximal ulna. RESULTS The study included 15 male and 13 female patients, with a mean follow-up period of 32 ± 14 months (range, 12-61 months). An associated dislocation was presented in 8 (29%). Mean extension and flexion were 2° ± 8° (range, -10° to 30°) and 139° ± 11° (range, 110°-155°), respectively. Mean pronation and supination were 74° ± 3° (range, 60°-75°) and 83° ± 9° (range, 40°-85°), respectively. Of the patients, 78% rated their elbow as being normal or nearly normal. The mean Mayo Elbow Performance Score was 95 ± 9 (range, 70-100). The mean Disabilities of the Arm, Shoulder and Hand score was 7 ± 13 (range, 0-57). The mean coronoid fracture height was 5.7 ± 1.2 mm (range, 3.7-7.9 mm). The mean percentage of coronoid height fractured was 33% ± 6% (range, 23%-43%). Mean fracture displacement was 2.7 ± 2 mm (range, 1-9 mm). Of the fractures, 23 (82%) were located at the anteromedial coronoid. CONCLUSION An ICF with a perfectly reduced ulnohumeral joint, a competent sublime tubercle, and a fractured coronoid height up to 50% can be treated without surgery with excellent or good results in more than 90% of cases regardless of the location of the fracture in the coronoid or the type of soft tissue-associated disruptions.
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Affiliation(s)
- Antonio M Foruria
- Shoulder and Elbow Reconstructive Surgery Unit, Orthopedic Surgery and Trauma Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - Begoña Gutiérrez
- Muscle-Skeletal Radiology Unit, Radiology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Jesús Cobos
- Shoulder and Elbow Reconstructive Surgery Unit, Orthopedic Surgery and Trauma Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - David L Haeni
- Shoulder and Elbow Reconstructive Surgery Unit, Orthopedic Surgery and Trauma Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Maria Valencia
- Shoulder and Elbow Reconstructive Surgery Unit, Orthopedic Surgery and Trauma Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Orthopedic Surgery and Trauma Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
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13
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Varus Posteromedial Rotatory Instability of the Elbow: Injury Pattern and Surgical Experience of 27 Acute Consecutive Surgical Patients. J Orthop Trauma 2018; 32:e469-e474. [PMID: 30444800 DOI: 10.1097/bot.0000000000001313] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To identify associated injuries that occur in varus posteromedial rotatory instability (VPMRI) of the elbow and present their surgical management. DESIGN Level II retrospective study. SETTING Tertiary referral center. PATIENT/PARTICIPANTS Twenty-seven patients with VPMRI injuries treated surgically over an 8-year period. INTERVENTION Open reduction and internal fixation of anteromedial coronoid facet fracture, lateral collateral ligament repair, and associated injured soft-tissue repairs. MAIN OUTCOME MEASURED Radiographic classification, associated medial and lateral bony and soft-tissue injuries, surgical fixation method, and complications were recorded. RESULTS According to the O'Driscoll classification, there were 15 (55%) type 2-2, 11 (41%) type 2-3, and 1 (4%) type 3-1 fractures. Lateral and medial collateral ligament tears were found in 100% and 63%, respectively. Common extensor and flexor origin injuries occurred in 19 (70%) and 2 (7%) elbows, respectively. A marginal radial head fracture was found in 1 patient. Most patients were treated with a combination of fixation methods. Complications occurred in 7 (26%) patients. CONCLUSIONS This study documents both associated findings and surgical fixation methods. In all cases, the lateral collateral ligament was disrupted, often in association with an injured common extensor origin. Medial collateral ligament injuries are commonly involved. Radial head fractures are rarely associated. The surgeon should have a high index of suspicion if an isolated coronoid fracture is encountered. Clinical and functional outcome scores are needed in future studies to further inform treatment of VPMRI of the elbow. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Chen HW, He HH, Gao BL. Efficacy of internal fixation with mini plate and internal fixation with hollow screw for Regan-Morrey type II and III ulna coronoid fractures. BMC Musculoskelet Disord 2018; 19:194. [PMID: 29921248 PMCID: PMC6011204 DOI: 10.1186/s12891-018-2117-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ulna coronoid fracture is a complicated injury and occurred in the coronal plane. Undeniably, there is no universally accepted approach for treating ulna coronoid fractures. Therefore, this study aimed at exploring the efficacy of different surgical treatments for Regan-Morrey type II and III ulna coronoid fractures. METHODS A total of 164 patients with ulna coronoid fractures were admitted and treated in department of orthopedics at Yiwu Central Hospital, the Affiliated Yiwu Hospital of Wenzhou Medical University for retrospective analysis. The baseline features (age, gender, time from injury to surgery and so on) before the surgery and different conditions during the surgery were compared. Following that, the Visual Analogue Scale (VAS) pain score was employed to evaluate the severity of preoperative and postoperative pain experienced by the patients in each group. Afterwards, Broberg and Morrey elbow score was used to evaluate elbow joint function and surgical effect of the patients. Lastly, the postoperative recovery and complications were compared. RESULTS It was firstly observed that internal fixation with mini plate and hollow screw compelled to lower average operation time and blood loss than Kirschner wire and steel wire suture. Next, the severity of postoperative pain was lessened in comparison with preoperative pain. Afterwards, mini plate and hollow screw improved elbow joint function more notable than Kirschner wire and steel wire suture, and Kirschner wire and steel wire suture resulted in higher incidence of complications and worse postoperative recovery. CONCLUSION Collectively, this study clarified that for the treatment of Regan-Morrey type II and III ulna coronoid fractures, internal fixation with mini plate and hollow screw has an overall superior surgical effect than internal fixation with Kirschner wire and steel wire suture.
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Affiliation(s)
- Hong-Wei Chen
- Department of Orthopedic Surgery, Yiwu Central Hospital, the Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, 322000, People's Republic of China
| | - Hong-Hui He
- Department of Joint Surgery and Sports Medicine, the Affiliated Nanhua Hospital, University of South China, Hengyang, 421002, People's Republic of China
| | - Bin-Li Gao
- Department of Orthopedics, the Affiliated Hospital of Inner Mongolia Medical University, No. 1, Tongdao North Road, Hohhot, 010050, The Inner Mongolia Autonomous Region, People's Republic of China.
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15
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Wang P, Zhuang Y, Li Z, Wei W, Fu Y, Wei X, Zhang K. Lasso plate - An original implant for fixation of type I and II Regan-Morrey coronoid fractures. Orthop Traumatol Surg Res 2017; 103:447-451. [PMID: 28185992 DOI: 10.1016/j.otsr.2016.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 10/25/2016] [Accepted: 12/06/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Coronoid fractures are notoriously difficult to manage particularly when there is a small fragment. We report a retrospective analysis of our experience with consecutive type I and II Regan-Morrey coronoid fractures using a lasso plate. HYPOTHESIS Type I and II Regan-Morrey coronoid fractures can be effectively managed using a lasso plate. METHODS From October 2011 and December 2013, 25 patients (21 males and 4 females, mean age 40.0 years) with type I and II Regan-Morrey coronoid fractures were treated with the open reduction and internal fixation (ORIF) using the lasso plate. Postoperative measurements of the elbow range of motion were recorded. Elbow function was evaluated by the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS All patients were reexamined at a mean follow-up of 32.7 months (range: 24-49 months). The mean fractures healing time was 13.6 weeks (range: 6 to 18 weeks). The mean flexion range of the elbow was 121.8° (range: 90° to 135°) and the mean extension range of the elbow was 10.6° (range: 0° to 20°). The mean pronation of the forearm was 75.8° (range: 65° to 85°). The mean supination of the forearm was 80.4° (range: 70° to 90°). The mean DASH score was 10.2 (range: 0 to 28). The mean MEPS was 83.4 (range: 55 to 95), 8 patients (32%) were rated excellent, 14 patients (56%) were rated good, 2 (8%) patients were rated fair. One (4%) patient was rated poor. No patient was seriously infected but implant breakage was found in one case. Two cases of elbow heterotopic ossification (HO) were observed. Two cases of elbow medial instability were observed. DISCUSSION The type I and II Regan-Morrey coronoid fractures combined with the instability of the elbow should be operated. The lasso plate reduces the pressure between the wire and the insertion of capsule. A tight wire results in greater stability than ordinary suture fixation, thus enabling early functional exercise. CONCLUSION In the treatment of type I and II Regan-Morrey coronoid fractures, lasso plate can provide concentric fracture reduction of the elbow and stable fixation to allow for early rehabilitation. Good clinical outcomes can be anticipated. LEVEL OF EVIDENCE Level IV: retrospective study.
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Affiliation(s)
- P Wang
- Department of orthopedics and trauma, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No. 555, East Friendship Road, Xi'an City 710054, Shaanxi Province, China
| | - Y Zhuang
- Department of orthopedics and trauma, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No. 555, East Friendship Road, Xi'an City 710054, Shaanxi Province, China
| | - Z Li
- Department of orthopedics and trauma, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No. 555, East Friendship Road, Xi'an City 710054, Shaanxi Province, China
| | - W Wei
- Department of orthopedics and trauma, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No. 555, East Friendship Road, Xi'an City 710054, Shaanxi Province, China
| | - Y Fu
- Department of orthopedics and trauma, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No. 555, East Friendship Road, Xi'an City 710054, Shaanxi Province, China
| | - X Wei
- Department of orthopedics and trauma, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No. 555, East Friendship Road, Xi'an City 710054, Shaanxi Province, China
| | - K Zhang
- Department of orthopedics and trauma, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No. 555, East Friendship Road, Xi'an City 710054, Shaanxi Province, China.
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Sakai K, Shirahama M, Shiba N, Yoshida K, Yoshida S. Primary Hinged External Fixation of Terrible Triad Injuries and Olecranon Fracture-Dislocations of the Elbow. Kurume Med J 2017; 63:7-14. [PMID: 28090003 DOI: 10.2739/kurumemedj.ms6300003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study aimed to introduce a new treatment that apples primary hinged external fixation for complex fracture-dislocations of the elbow in 12 cases. We retrospectively assessed the functional outcomes of eight patients with terrible triad injuries and three patients with an olecranon fracture-dislocation of the elbow, who were treated at our hospital using a primary hinged external fixator between June 2012 and December 2014. Ten patients underwent repair or replacement of the radial head, while three underwent repair of the olecranon. In principle, they were treated without reconstruction of the coronoid fracture and collateral ligament injury. The patients were evaluated for a mean follow-up period of 16 months after the initial surgery. Early mobilization was encouraged while the hinged external fixator was in place. At the follow-up, the mean Mayo Elbow Performance Score was 93 points; the results were "excellent" in six cases and "good" in five. No patients had recurrent elbow instability. Only one patient needed an additional procedure after the initial operation. These results suggested that primary hinged external fixation without repair of the ligament and soft tissue is an effective minimally invasive surgery for the management of terrible triad injuries and olecranon fracture-dislocations of the elbow.
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Affiliation(s)
- Kensuke Sakai
- Department of Orthopedic Surgery, St. Mary's Hospital
| | | | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University
| | - Kenji Yoshida
- Department of Orthopedic Surgery, St. Mary's Hospital
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17
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Shen L, Yu X, Zhong B, Ding J. A figure-eight suture loop with Kirschner wires for fixation of anteromedial coronoid process fractures: A case series. Int J Surg Case Rep 2017; 33:130-134. [PMID: 28315817 PMCID: PMC5358819 DOI: 10.1016/j.ijscr.2017.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 11/25/2022] Open
Abstract
Eleven cases with a fracture of the anterior or anteromedial facet of the coronoid process were treated by coronoid fixation using a figure-eight suture loop. All 11 fractures were united at final follow-up with no joint incongruity, dislocation, or subluxation of the injured elbow. The figure-eight suture pattern technique is an easy and effective technique to fix anterior or anteromedial facet fractures of the coronoid process. Purpose Sufficient fixation of an anterior or anteromedial facet fracture of the coronoid process in fracture-dislocation of elbow is important to maintain joint stability. The purpose of this study was to report our experience with 11 patients who were managed with an original fixation technique using a “figure-eight” suture loop. Methods From February 2010 to March 2011, 11 cases with a fracture of the anterior or anteromedial facet of the coronoid process were treated by coronoid fixation using a figure-eight suture loop. For cases with comminuted fractures, to prevent a suture from sliding into the fracture line, a 3- or 4-hole phalanx plate was enclosed in the suture loop to compress multiple fragments. Accompanying injuries, such as a radial head fracture or olecranon fracture, were fixed with repair of lateral collateral ligament injuries. Results On final evaluations at an average of 18 months after injury, the mean elbow arc of motion was 125.5° and the mean forearm rotation arc of 124.1°. All fractures were united with an average postoperative score according to the Mayo Elbow Performance Index of 91 points. All patients achieved satisfactory scores (seven excellent, four good). All 11 fractures were united at final follow-up with no joint incongruity, dislocation, or subluxation of the injured elbow. Conclusions The figure-eight suture loop technique is an easy and effective technique to fix anterior or anteromedial facet fractures of the coronoid process.
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Affiliation(s)
- Longxiang Shen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, PR China
| | - Xingang Yu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, PR China
| | - Biao Zhong
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, PR China
| | - Jian Ding
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, PR China.
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Tarassoli P, McCann P, Amirfeyz R. Complex instability of the elbow. Injury 2017; 48:568-577. [PMID: 24161720 DOI: 10.1016/j.injury.2013.09.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 09/02/2013] [Accepted: 09/19/2013] [Indexed: 02/02/2023]
Abstract
Injuries to the elbow are commonly encountered in orthopaedic practice. They range from low energy, simple isolated fractures, to high energy complex fracture dislocations with severe ligamentous disruption. Recognising the precise pattern of injury is critical in restoring elbow function and preventing chronic instability, pain and weakness. This article discusses the important osseous and ligamentous stabilisers of the elbow joint and provides management protocols for the common patterns of complex injury encountered by the practising surgeon.
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Affiliation(s)
- Payam Tarassoli
- Department of Trauma and Orthopaedics, University Hospitals Bristol NHS Trust, Level 5, Queens Building, Upper Maudlin Street, Bristol BS2 8HW, United Kingdom.
| | - Philip McCann
- Department of Trauma and Orthopaedics, University Hospitals Bristol NHS Trust, Level 5, Queens Building, Upper Maudlin Street, Bristol BS2 8HW, United Kingdom
| | - Rouin Amirfeyz
- Department of Trauma and Orthopaedics, University Hospitals Bristol NHS Trust, Level 5, Queens Building, Upper Maudlin Street, Bristol BS2 8HW, United Kingdom
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19
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Abstract
Coronoid fractures commonly occur in a part of unstable elbow fractures. Stable coronoid fracture fixation is important for early elbow motion. It may be difficult to fix multifragmented coronoid process fractures with loose capsular attachment. Thus, we demonstrated the endobutton suspensory technique to fix the anterior coronoidal fragments due to its suspensory effect providing capsular attachment. This technique allows stable fixation to the small multifragmented coronoid fractures with early range of motion.
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20
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Ozel O, Demircay E. Review of management of unstable elbow fractures. World J Orthop 2016; 7:50-54. [PMID: 26807356 PMCID: PMC4716571 DOI: 10.5312/wjo.v7.i1.50] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/12/2015] [Accepted: 11/04/2015] [Indexed: 02/06/2023] Open
Abstract
Stable and painless elbow motion is essential for activities of daily living. The elbow joint is the second most commonly dislocated joint in adults. The goals of treatment are to perform a stable fixation of all fractures, to achieve concentric and stable reduction of the elbow and to provide early motion. The treatment modality for complex elbow instability is almost always surgical. The treatment objectives are anatomic reduction, stable fixation, and early rehabilitation of the elbow. The common complications of these unstable fractures include recurrent instability, stiffness, myositis ossifications, heterotopic calcification, and neurovascular dysfunction. We analyzed the management of complex elbow fractures and instabilities on the basis of recent literature and suggested possible guidelines for the treatment in this paper. In conclusion, recognition of the injury pattern and restoration of the joint stability are the prerequisites for any successful treatment of an unstable elbow injury.
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21
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Jennings JD, Hahn A, Rehman S, Haydel C. Management of Adult Elbow Fracture Dislocations. Orthop Clin North Am 2016; 47:97-113. [PMID: 26614925 DOI: 10.1016/j.ocl.2015.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Elbow fracture dislocations are complicated injuries that are difficult to manage and fraught with complications. A complete series of radiographs is typically complemented with CT scan to evaluate the elbow and assist preoperative planning. Typically, operative intervention is necessary and a systematic approach to the elbow injuries should be chosen. This article addresses the coronoid and proceeds to the radial head, lateral soft tissues, and finally the medial ligaments if elbow instability persists. With a focused, systematic surgical approach, improved outcomes have been demonstrated and patients may recover full function and range of motion in the affected elbow.
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Affiliation(s)
- John D Jennings
- Department of Orthopedic Surgery and Sports Medicine, Temple University Hospital, 3501 North Broad Street, Philadelphia, PA 19140, USA.
| | - Alexander Hahn
- Department of Orthopedic Surgery and Sports Medicine, Temple University School of Medicine, 3501 N. Broad St, Philadelphia, PA 19102, USA
| | - Saqib Rehman
- Department of Orthopedic Surgery and Sports Medicine, Temple University Hospital, 3501 North Broad Street, Philadelphia, PA 19140, USA
| | - Christopher Haydel
- Department of Orthopedic Surgery and Sports Medicine, Temple University Hospital, 3501 North Broad Street, Philadelphia, PA 19140, USA
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22
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Xiao K, Zhang J, Li T, Dong YL, Weng XS. Anatomy, definition, and treatment of the "terrible triad of the elbow" and contemplation of the rationality of this designation. Orthop Surg 2015; 7:13-8. [PMID: 25708030 DOI: 10.1111/os.12149] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/05/2014] [Indexed: 12/01/2022] Open
Abstract
In the realm of orthopaedics, the terrible triad of the elbow is infamous, not simply because the prognosis is poor for most patients, but also, maybe to a greater extent, because the unique name of this malady attracts considerable attention and interest in both doctors and patients. The adjective terrible is bestowed on an elbow triad that comprises three coexisting complicated traumas; namely, radial head and ulnar coronoid process fractures and posterior dislocation of the elbow joint. In this review, the classification, treatment principles and prognosis for different forms of management of the radial head and ulnar coronoid process fractures and the ligaments lesions are introduced sequentially and various surgical procedures and their efficacy are discussed. This triad has long given orthopedic surgeons headaches. Nonetheless, in recent years a series of anatomical mechanical studies on the elbow joint have been published and there have been several breakthroughs in surgical techniques for managing this elbow triad. This review examines some memorable millstones and unveils trends in the current clinical norm for this triad. The accomplishments achieved recently have reportedly resulted in enhanced prognoses in the last two or three years compared with previous years. It is therefore high time to revise our thoughts about the justice and accuracy of defining this triad of the elbow as terrible. Lastly, we may safely conclude that the terrible triad of the elbow is much less terrible than previously, provided the commonly approved clinical approaches are undertaken.
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Affiliation(s)
- Ke Xiao
- Orthopaedic Department of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Abstract
Varus posteromedial instability of the elbow is a result of traumatic injury to the medial facet of the coronoid and usually the lateral collateral ligament. Treatment of these fractures is usually surgical; poor outcomes have been described with nonoperative treatment. Surgical management consists of coronoid fracture fixation with plates, screws, or sutures and radial collateral ligament repair. Outcomes of these injuries are mixed, but most series report fair to good objective scores. The purpose of this article is to describe the pathophysiology of varus posteromedial instability, discuss the management of this injury, and report the outcomes of treatment.
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Affiliation(s)
- Miguel A Ramirez
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD 21218, USA
| | - Jason A Stein
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD 21218, USA
| | - Anand M Murthi
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD 21218, USA.
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Park SM, Lee JS, Jung JY, Kim JY, Song KS. How should anteromedial coronoid facet fracture be managed? A surgical strategy based on O'Driscoll classification and ligament injury. J Shoulder Elbow Surg 2015; 24:74-82. [PMID: 25304044 DOI: 10.1016/j.jse.2014.07.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/18/2014] [Accepted: 07/25/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite an improved understanding of coronoid anteromedial facet (AMF) fractures, the optimal treatment protocol and technique have not yet been established. The goals of the study were to describe the characteristics of AMF fractures, to suggest a surgical strategy, and to report the outcomes after treatment according to this protocol. METHODS This was a retrospective study of 19 patients with AMF fractures between 2010 and 2012. Eight patients were excluded because of secondary olecranon fracture, radial head fracture, and elbow dislocation, leaving 11 patients with isolated AMF fracture in the study cohort. There were 7 men and 4 women, with an average age of 42 years (range, 29-62 years). Fracture classification, injury pattern, and accompanying collateral ligament injury were analyzed. O'Driscoll subtype 1 fractures were treated with lateral collateral ligament (LCL) repair; O'Driscoll subtype 2 and subtype 3 fractures were treated with buttress plating and LCL repair. Plain radiographs were used to evaluate union, arthritic change, and joint articulation. Functional outcomes were evaluated with range of motion and the Mayo Elbow Performance Score. RESULTS Two patients had O'Driscoll anteromedial subtype 1 fracture, 4 patients had subtype 2, and 5 patients had subtype 3. Two patients with subtype 1 fracture had associated posterior dislocation; 9 patients with subtype 2 or subtype 3 had associated varus posteromedial injury. All 11 patients had associated LCL injury, and 6 patients had associated medial collateral ligament injury. The mean range of motion was 128°, and the average Mayo Elbow Performance Score was 89 points. Qualitatively, patient outcomes were scored excellent in 4 patients, good in 6 patients, and fair in 1 patient. CONCLUSION AMF fractures are almost always accompanied by collateral ligament injuries. Thus, our surgical strategies, which include collateral ligament repair, are able to stabilize and result in favorable clinical outcomes. On the basis of our results, we recommend LCL repair alone for subtype 1 fractures and buttress plating and LCL repair for subtype 2 and subtype 3 fractures.
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Affiliation(s)
- Sang-Min Park
- Department of Orthopaedic Surgery, Chung-Ang University, College of Medicine, Seoul, South Korea
| | - Jae Sung Lee
- Department of Orthopaedic Surgery, Chung-Ang University, College of Medicine, Seoul, South Korea.
| | - Jee Young Jung
- Department of Radiology, Chung-Ang University, College of Medicine, Seoul, South Korea
| | - Jae Yoon Kim
- Department of Orthopaedic Surgery, Chung-Ang University, College of Medicine, Seoul, South Korea
| | - Kwang-Sup Song
- Department of Orthopaedic Surgery, Chung-Ang University, College of Medicine, Seoul, South Korea
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Giannicola G, Polimanti D, Gumina S, Cinotti G. Use of fine-threaded K-wires in the treatment of coronoid fractures in complex elbow instability. Orthopedics 2013; 36:e1233-8. [PMID: 24093696 DOI: 10.3928/01477447-20130920-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The coronoid process is one of the main elbow constraints that provides ulnohumeral joint stability. Coronoid fractures may be fixed using multiple techniques, including transosseous sutures, screws, and plates. The goal of this study was to analyze the clinical and radiographic outcomes in a series of patients with complex elbow instability in whom coronoid fractures were repaired using fine-threaded K-wires. Eight men and 10 women (mean age, 47 years) were followed prospectively for a mean of 26 months. Surgical treatment consisted of open reduction and internal fixation of all fractures; radial head replacement in Mason III injuries; lateral collateral ligament repair in all patients; and, in cases of persistent instability, medial collateral ligament repair, hinged fixator application, or both. Coronoid fixation was performed using 2 or more fine-threaded K-wires, depending on the fragment size, inserted from the posterior aspect of the ulna and directed toward the coronoid fragment using a 1-step fixation technique. At last follow-up, mean extension was 15°, mean flexion was 133°, mean pronation was 78°, and mean supination was 69°; mean Disabilities of the Arm, Shoulder and Hand score was 9.7, mean American Shoulder and Elbow Surgeons score was 85, and mean Mayo Elbow Performance Score was 89. According to the Mayo Elbow Performance Index, 10 excellent, 7 good, and 1 fair result were recorded. All but 1 patient had a stable elbow. Fracture healing was observed in all but 1 patient. No secondary coronoid fragment dislocation or implant failures were reported. This study shows that using fine-threaded K-wires provides easy, minimally invasive, stable, and successful 1-step fixation that can be used to obtain osteosynthesis of coronoid fractures in patients with complex elbow instability.
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