Comparison of arthroscopy-assisted vs. open reduction and fixation of coronoid fractures of the ulna

Excellent clinical and radiological outcomes after arthroscopic reduction and double row-suture bridge for large-sized greater tuberosity fractures of the humerus

PURPOSE

Currently, there is limited information on the clinical outcomes of arthroscopic reduction and double-row suture bridge fixation for large greater tuberosity fractures of the proximal humerus. This study aimed to evaluate the radiological and clinical outcomes of arthroscopic reduction and double-row suture bridge fixation for these fractures, hypothesizing that arthroscopic reduction and double-row suture bridge fixation is a safe, effective and minimally invasive treatment for large greater tuberosity fractures.

METHODS

This retrospective study analysed patients with large greater tuberosity fractures (fracture fragment ≥30 mm in diameter) who underwent arthroscopic reduction and double-row suture bridge fixation and had a follow-up period exceeding 2 years. The anatomic reduction was confirmed by assessing the step-off on radiographs immediately after surgery, and the radiologic union time was recorded. At the final follow-up, range of motion and functional outcome scores were evaluated. Additionally, any surgery-related complications were evaluated.

RESULTS

Fifteen patients with a mean follow-up of 57.7 ± 23.1 months were included in the study. The mean fracture fragment size was 32.5 ± 2.4 mm, with a mean displacement of 5.1 ± 1.6 mm. Immediately postsurgery, 13 of 15 patients (86.7%) had a fracture step-off of <3 mm, with an average union time of 3 months. At the final follow-up, patients demonstrated excellent outcomes, with an average forward flexion of 167 ± 9.7° and external rotation of 70 ± 16.3. Functional outcome scores showed significant improvement compared with preoperative scores (p < 0.001). No major surgery-related complications were reported.

CONCLUSIONS

Arthroscopic reduction and double-row suture bridge fixation for large-sized greater tuberosity fractures is safe and shows good fracture reduction and excellent clinical outcomes. Therefore, this surgical method can be considered an alternative to open reduction for large greater tuberosity fractures.

LEVEL OF EVIDENCE

Level IV.

Surgical Treatment of Coronoid Fracture With Elbow Varus Posteromedial Rotatory Instability: An Instructional Review

Varus posteromedial rotatory instability (VPMRI) of the elbow is one of the complex elbow instability. The primary sites of injury encompass fractures of the anteromedial coronoid process and injuries to the lateral collateral ligament of the elbow. Some patients may present with involvement of the medial collateral ligament of the elbow. Owing to its distinctive injury mechanism and imaging characteristics, this condition is infrequent in clinical practice and susceptible to misdiagnosis and missed diagnosis. Literature reviews indicate that conservative management of VPMRI is associated with numerous complications, such as persistent pain, traumatic arthritis, and chronic elbow instability. Consequently, surgical intervention has emerged as the recommended treatment modality. Nonetheless, the lack of systematic research on VPMRI in clinical practice has been inconclusive regarding the optimal internal fixation techniques and surgical approaches. Therefore, investigating the treatment modalities, surgical techniques, and internal fixation strategies for VPMRI associated with coronoid fractures holds substantial importance for informing clinical management. In this review, we systematically synthesize the existing literature on coronoid fractures with VPMRI for offering a valuable reference for future clinical treatment.

The sub pronator approach to the coronoid process

INTRODUCTION

The aim of our study was to describe a new anteromedial approach that allows exposure of the anteromedial facet of the coronoid process and to characterize the position of the median nerve's motor branches relative to this approach in relation to elbow positioning.

MATERIAL AND METHODS

We performed 16 anteromedial approaches on fresh anatomical specimens. The minimum distance between the medial edge of the trochlea and the second branch of the median nerve was measured in three elbow positions: forearm in supination with the elbow extended, forearm in pronation with the elbow extended, and forearm in supination with the elbow flexed at 90 °. The distance between the joint space and the origin of the first two motor branches of the median nerve was then measured with the elbow extended.

RESULTS

The mean distance between the second motor branch of the median nerve and the medial edge of the trochlea was 13 mm ± 3 mm with the elbow extended and forearm supinated; 5 mm ± 3 mm with the elbow extended and forearm pronated; and 11 mm ± 4 mm with the elbow flexed at 90 ° and forearm supinated. There was a significant difference in distance between the measurement in the pronated position and the two measurements in the supinated positions. However, there was no significant difference between the measurement with the elbow flexed in supination and the elbow extended in supination (p < 0.06).

CONCLUSION

The subpronator approach is a reproducible and reliable approach that allows exposure of the tip of the coronoid process and its anteromedial facet, up to the insertion of the anterior bundle of the medial collateral ligament on the sublime tubercle. We have shown that placing the forearm in supination moves the motor branches at risk of injury away from the surgical site.

LEVEL OF EVIDENCE

V.

Suture button systems for coronoid fracture fixation: a biomechanical time-zero pilot study

PURPOSE

This study aims to describe a fixation technique for coronoid fractures using suture buttons, and to biomechanically evaluate this technique in comparison to screw fixation as a time-zero pilot study.

METHODS

An O'Driscoll type 2 anteromedial coronoid facet (AMCF) fracture was simulated in 20 fresh-frozen human elbows. The specimens were randomized into two groups and fracture fixation was performed with either a suture button system or a 3.5 mm cannulated screw. Ultimate load-to-failure (N) was then tested for each specimen.

RESULTS

The mean load-to-failure was 322.6 ± 75.9 N for suture button fixation and 314.2 ± 85.9 N for screw fixation. The differences were not statistically significant (p = 0.432). Additional fracturing of the coronoid fragment was observed in two specimens with screw fixation.

CONCLUSION

Promising biomechanical evaluations show that this fixation technique using suture buttons in the treatment of coronoid fractures provides equal construct stability as screw fixation. Further studies are required to fully validate this procedure.

Surgical outcomes and complication rates of arthroscopic-assisted fixation versus open fixation for coronoid fractures: A systematic review and meta-analysis

Background

Coronoid fractures often occur with complex elbow dislocations, accounting for 15% of elbow fractures. The effectiveness of open reduction internal fixation (ORIF) versus arthroscopic-assisted reduction internal fixation (ARIF) surgeries for coronoid fractures remains uncertain. This study aimed to compare the outcomes of these two surgical approaches in treating varus posteromedial injuries.

Methods

This study was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study protocol was registered with PROSPERO. The primary outcomes assessed in this study were the functional outcomes measured by the Mayo Elbow Performance Score (MEPS) and the complications associated with each surgical approach.

Results

Analysis of the data from 759 patients included in this study revealed that the mean postoperative MEPS score was higher in the ARIF group compared to the ORIF group (97.5 Vs. 90.7), with the mean improvement in MEPS was 16.6 points (19 for ORIF and 14.3 for ARIF). The complication rate in the ORIF group was 24.6%, while the ARIF group reported a complication rate of 6%.

Conclusion

This study suggests that ARIF surgery can yield comparable and promising outcomes to ORIF surgery for coronoid fractures.

Level of evidence

IV.

Medial elbow approaches for coronoid fractures: risk to the ulnar nerve

Background

Coronoid fractures often require open reduction internal fixation (ORIF) to restore elbow stability. The flexor pronator split, flexor carpi ulnaris (FCU) split, and Taylor and Scham (T&S) approaches are frequently used medial approaches to access the coronoid. The ulnar nerve can be released or transposed when performing these exposures. The optimal medial surgical approach and management of the ulnar nerve has not been clearly defined. The purpose of this study was to compare postoperative ulnar nerve complications in coronoid fractures undergoing ORIF following a medial surgical approach and ulnar nerve release or transposition.

Methods

A retrospective review of 91 patients with coronoid fractures treated with ORIF using a medial approach from 2004 to 2022 was performed at three academic medical centers. Patients ≥ 18 years of age who sustained coronoid fractures with or without associated injuries were included. Patient charts and perioperative imaging were reviewed. Patient demographics, fracture classification, associated injuries, surgical approaches, ulnar nerve management, and postoperative complications were recorded. Primary outcomes assessed were signs and symptoms of postoperative ulnar nerve neuropathy.

Results

The mean age of the cohort was 45 ± 16 years, 71% were males, with a mean length of follow-up of 16 ± 22 months. Of the 91 coronoid fractures, 69 were anteromedials, eight were tips, and 14 were basal types. The incidence of preoperative ulnar neuropathy was 5% (n = 5). The incidence of postoperative ulnar neuropathy was 33% (n = 30) of which 55% (n = 16) completely resolved by final follow-up. The rate of postoperative ulnar neuropathy was not significantly different between in situ release 30% (n = 9) or transposition of the ulnar nerve 34% (n = 20), (P = .64). There was a significantly higher rate of postoperative resolution with transposition (70%) versus in situ release (22%), (P = .045). The rate of postoperative ulnar neuropathy was not significantly different between the FCU, T&S, or flexor pronator split approaches, (P = .331). Finally, the rate of neuropathy resolution was not significantly different between medial approaches (P = .46).

Conclusion

There was no statistical difference in the incidence of postoperative ulnar nerve complications with ulnar nerve transposition or in situ release following coronoid fixation. However, transposing the nerve resulted in a higher rate of neuropathy resolution. While the incidence of postoperative ulnar nerve dysfunction is high following coronoid fixation when using a medial surgical approach, it was similar with the FCU, T&S, and flexor pronator split approaches. Larger cohorts and randomized clinical trials are needed to confirm these findings.

Optimal K-Wire Placement for Indirect Cannulated Screw Fixation of Coronoid Process Fractures: A Radiology-Based Guide

PURPOSE

Indirect fixation of coronoid process fractures of the ulna, especially arthroscopically, offers the possibility to avoid extensive medial surgical approaches. However, optimal placement of K-wires for cannulated screw fixation is technically challenging. The aim of the present study was to present guide values for K-wire placement for indirect screw fixation of coronoid tip (COT) and anteromedial facet (AMF) fractures of the ulna.

METHODS

Computed tomography scans of the elbows of 197 patients with an uninjured ulna were identified and evaluated following a standard measuring protocol. Optimal placement of K-wires was defined as the bisector between the anterior and articular cortex while respecting a 1.6-mm safe zone for each placement. This placement of the K-wires in the COT and the AMF was analyzed by measuring the wire angulation in relation to the posterior ulnar cortex (AUC), the distance from the entry point to the posterior olecranon edge (DPE), and the intraosseous length (IOL). Because the coronoid has a curved shape, measurements of the COT and AMF were expected to differ significantly. Sex was also expected to influence measurements. To determine whether this optimal placement of K-wires can be reliably identified, interobserver and intraobserver reliabilities were evaluated.

RESULTS

To address tip fragments, we determined a mean AUC of 64°, DPE of 36 mm, and IOL of 38 mm. Regarding wire placement toward the AMF, the means for the AUC, DPE, and IOL were 79°, 27 mm, and 33 mm, respectively. Statistically significant differences were found between the COT and the AMF for the AUC, DPE, and IOL. Our measuring protocol showed good interobserver and intraobserver reliability.

CONCLUSIONS

K-wire placement toward the COT demands a smaller angle, a longer IOL, and a more distal entry point than wires placed toward AMF. These differences reflect the curved and complex anatomy of the coronoid.

CLINICAL RELEVANCE

This measuring algorithm can be used to plan osteosynthesis, and the obtained reference values can help understand the coronoid's complex anatomy.

Coronoid fractures and complex elbow instability: current concepts

Fractures of the coronoid process typically occur as part of more complex injury patterns, such as terrible triads, trans-olecranon fracture-dislocations, posteromedial rotatory injuries or Monteggia-like lesions. Each pattern is associated with a specific type of coronoid fracture with regard to shape and size and specific soft-tissue lesions. O' Driscoll classification incorporates those associations identifying three major types of fractures: tip, anteromedial facet, and basal fractures. The objective of this study is to review the most common types of complex elbow instability, identify the indications for coronoid fixation and guide the appropriate management. Tip fractures as those seen in terrible triads can conditionally left untreated provided that elbow stability has been restored after radial head fixation and ligaments repair. Anteromedial facet fractures benefit from a buttress plate, while large basilar fractures can be effectively secured with posteroanterior screws. Coronoid reconstruction with a graft should be considered in post-traumatic cases of chronic coronoid deficiency.

Considerable variation in current coronoid height and fracture measurement techniques: a systematic review

BACKGROUND

Coronoid fractures usually occur in the presence of a significant osseoligamentous injury to the elbow. Fracture size and location correlate with degree of instability and many authors have attempted to analyze the effect of fracture variation on decision making and outcome. There remains no standardized technique for measuring coronoid height or fracture size. The aim of this study was to appraise the literature regarding techniques for coronoid height measurement in order to understand variation.

METHODS

Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines were followed. A search was performed to identify studies with either a description of coronoid height, fracture size, or bone loss using the terms (Coronoid) AND (Measurement) OR (Size) OR (Height). Articles were shortlisted by screening for topic relevance based on title, abstract and, if required, full-text review. Exclusion criteria were non-English articles, those on nonhuman species or parts other than the ulna coronoid process, and studies that included patients with pre-existing elbow pathology. Shortlisted articles were grouped based on study type, imaging modality, measurement technique, and measurement parameter as well as its location along the coronoid.

RESULTS

Thirty out of the initially identified 494 articles met the inclusion criteria. Twenty-one articles were clinical studies, 8 were cadaveric studies, and 1 combined patients as well as cadavers. A variety of imaging modalities (plain radiographs, 2-dimensional computed tomography [CT], 3-dimensional CT, magnetic resonance imaging or a combination of these) were used with CT scan (either 2-dimensional images or 3-dimensional reconstructions or both) being the most common modality used by 21 studies. Measurement technique also varied from uniplanar linear measurements in 15 studies to multiplanar area and volumetric measurements in 6 studies to techniques describing various angles and indices as an indirect measure of coronoid height in 8 studies. Across the 30 shortlisted studies, 19 different measurement techniques were identified. Fifteen studies measured normal coronoid height while the other 15 measured intact coronoid and/or fracture fragment height. The location of this measurement was also variable between studies with measurements at the apex of the coronoid in 24/30 (80%) of studies. Measurement accuracy was assessed by only 1 study. A total of 12/30 (40%) studies reported on the interobserver and intraobserver reliability of their measurement technique.

CONCLUSION

The systemic review demonstrated considerable variability between studies that report coronoid height or fracture size measurements. This variability makes comparison of coronoid height or fracture measurements and recommendations based on these between studies unreliable. There is need for development of a consistent, easy to use, and reproducible technique for coronoid height and bone loss.

30-Day complications, operative time, and overnight admission following elective elbow arthroscopy

Background

Although arthroscopic procedures are generally considered safer than open procedures, they are not without complications. This study's purpose is to characterize patient demographics, medical complications, overnight admissions, and prolonged operative times for patients undergoing elective elbow arthroscopy using a national database.

Methods

This retrospective study used the ACS NSQIP database with data from 2015 to 2020. Patients undergoing elbow arthroscopy were identified, and those undergoing emergent surgery were excluded. Patient demographics, clinical characteristics, medical comorbidities, 30-day complications, overnight admission rates, and operative times were recorded and analyzed.

Results

Overall, 815 patients undergoing elective elbow arthroscopy were included. The mean age was 46.8 years. Mean BMI was 29.7 kg/m2, and 75.2% (n = 613) were male sex. The most common comorbidity was smoking (14.8%, n = 121). The cumulative complication rate was 2.5% (n = 20). The most common complication was surgical site infection (n = 7, 0.9%). 10.7% of patients required at least one overnight hospital stay. 20.2% of patients had a prolonged operative time ≥ 120 min.

Conclusion

Elbow arthroscopy is not without complications and morbidity despite being a minimally invasive procedure and advances made in surgical technique. Surgeons should use this information to facilitate shared-surgical decision making, preoperative patient counselling, and preoperative patient optimization.

The role of arthroscopy in the management of adult elbow trauma

Fractures around the elbow are often challenging to treat and in most cases require an extensive approach. Since the development of elbow arthroscopy, most authors have pointed out the potential advantages of a less invasive technique that can be useful for visualization and reduction of the articular fragments with an eventual percutaneous fixation. Arthroscopic techniques provide a limited exposure that may lead to a faster wound healing, lower rate of complications and thus, better recovery of range of motion. However, elbow arthroscopy is also a demanding technique, especially in a swollen and fractured joint, and it is not exempt of risks. The overall rate of complications has been rated from 1.5% to 11% and nerve injury rates from 1.26-7.5%.The objective of this review is to present the arthroscopic setup and general surgical technique for the management of elbow trauma and to define some clear indications. Patient positioning and operating room display is key in order to obtain success. In addition to the arthroscopic equipment, fluoroscopy is almost always necessary for percutaneous fixation and precise preparation is mandatory. In the last decade, literature regarding new portals or surgical tips for arthroscopic treatment of elbow fractures have been published.The main indications for fracture arthroscopic-assisted fixation are those articular fractures involving the coronoid, distal humerus shear fractures in the coronal plane (trochlear and capitellum fractures) and, more controversially, those affecting the radial head. The treatment of these type of fractures all arthroscopically is exponentially demanding as it might also require ligament repair. For coronoid fractures, it can be useful in Morrey type II and III, and O´Driscoll anteromedial facet fractures associated to a posteromedial instability pattern that also require a repair of the LCL. Although excellent results have been published, comparative series are scarce. Radial head fractures can also be approached arthroscopically in simple non-comminute fractures that can be fixed percutaneously.In conclusion, arthroscopy of the elbow is an excellent tool to better understand and visualize articular fractures of the elbow. However, despite the advances in surgical technique, whether it improves clinical and radiological results is still to be proven.

Prevalence, Timing, Locational Distribution, and Risk Factors for Heterotopic Ossification After Elbow Arthroscopy

BACKGROUND

Arthroscopic techniques aim to reduce complications and accelerate recovery of the elbow after treatments for posttraumatic stiffness, arthritis diseases, lateral epicondylitis, ligament reconstruction, and elbow trauma. However, data on the true prevalence and characteristics of heterotopic ossification (HO) formation after elbow arthroscopy are limited.

PURPOSE

To investigate the prevalence, timing, locational distribution, and risk factors of HO after elbow arthroscopy.

STUDY DESIGN

Cohort study; Level of evidence, 4.

METHODS

Data on 205 patients undergoing elbow arthroscopy by a single senior elbow surgeon at a single institution between May 2011 and January 2022 were retrospectively reviewed. The patients were evaluated at 2 weeks, 8 weeks, 6 months, and then annually after surgery or more frequently if HO developed, with a minimum of 1 year of postoperative follow-up. Postoperative anteroposterior and lateral elbow radiographs were taken at 2 weeks to rule out fracture and at 8 weeks to identify HO. The clinical outcomes were evaluated based on the pain visual analog scale; the shortened version of the Disabilities of the Arm, Shoulder and Hand score; Mayo Elbow Performance Score; and the Single Assessment Numeric Evaluation scores before and after surgery. Bivariate logistic regression analyses were used to determine factors affecting HO prevalence.

RESULTS

Thirteen (12 male, 1 female) of 205 (6.3%) patients developed HO, with 10 (76.9%) with HO that formed on the medial compartment of the elbow. Ten (76.9%) patients were diagnosed at 8 weeks after arthroscopic surgery, 1 (7.7%) at 6 months after surgery, and 2 (15.4%) at 12 months after surgery. HO was not found at 2 weeks after surgery in any patient. The mean follow-up time was 3.5 years (range, 1.0-11.8 years). Eleven asymptomatic patients were treated nonoperatively, and 2 symptomatic patients underwent HO excision arthroscopically or had a combination of open surgery and arthroscopy. Age was a protective factor for HO formation (odds ratio [OR], 0.953; 95% CI, 0.910-0.999; P = .047). The risk factors for HO formation were tourniquet time (OR, 1.042; 95% CI, 1.019-1.065; P < .001) and surgical time (OR, 1.026; 95% CI, 1.011-1.041; P < .001).

CONCLUSION

Among 205 patients who underwent elbow arthroscopy, HO was a minor complication of elbow arthroscopy, with a prevalence rate of 6.3%, and was usually located on the medial compartment of the elbow. Although the presence of HO may not affect the clinical outcomes in most patients, it should be carefully monitored for a minimum of 8 weeks postoperatively. Younger age, longer tourniquet time, and longer surgical time contributed to HO formation after elbow arthroscopy.

Coronoid fractures and traumatic elbow instability

The coronoid process is key to concentric elbow alignment. Malalignment can contribute to post-traumatic osteoarthritis. The aim of treatment is to keep the joint aligned while the collateral ligaments and fractures heal. The injury pattern is apparent in the shape and size of the coronoid fracture fragments: (1) coronoid tip fractures associated with terrible triad (TT) injuries; (2) anteromedial facet fractures with posteromedial varus rotational type injuries; and (3) large coronoid base fractures with anterior (trans-) or posterior olecranon fracture dislocations. Each injury pattern is associated with specific ligamentous injuries and fracture characteristics useful in planning treatment. The tip fractures associated with TT injuries are repaired with suture fixation or screw fixation in addition to repair or replacement of the radial head fracture and reattachment of the lateral collateral ligament origin. Anteromedial facet fractures are usually repaired with a medial buttress plate. If the elbow is concentrically located on computed tomography and the patient can avoid varus stress for a month, TT and anteromedial facet injuries can be treated nonoperatively. Base fractures are associated with olecranon fractures and can usually be fixed with screws through the posterior plate or with an additional medial plate. If the surgery makes elbow subluxation or dislocation unlikely, and the fracture fixation is secure, elbow motion and stretching can commence within a week when the patient is comfortable.

Arthroscopic-Assisted Fracture Fixation About the Elbow

Arthroscopic-assisted fracture fixation can be used for some adult elbow fractures. In particular, for articular fractures of the anterior elbow (coronoid/capitellum), elbow arthroscopy can provide excellent visualization of fracture fragments using a less invasive surgical exposure. Meticulous adherence to safe techniques and utilization of specialized equipment can help maximize safety and facilitate reproducible surgical results.

A Novel Suture-Preset Spring Plate System (SSPS) for Comminuted Coronoid Process Fracture in the Elbow

OBJECTIVE

This study is aimed to investigate the clinical outcomes of a novel SSPS for fixation of the comminuted coronoid fracture.

METHODS

A retrospective study was carried out in the patients with comminuted fractures of the coronoid treated by SPSS fixation between January 2014 and December 2018. A total of 17 patients (17 sides) was included in our study, including 11 male and six female, with a mean age range from 18 to 60. All cases started to functional rehabilitation immediately after the operation. Clinical outcomes were evaluated both radiographically and functionally at the follow-up visit, including the elbow instability, range of motion and Mayo elbow performance score (MEPS).

RESULTS

According to the O'Driscoll classification system, there was two side of type 1.2, two of type 2.1, four of type 2.2, three of type 2.3, two of 3.1 and four of type 3.2. The surgery was carried out by Kocher and anteromedial approach in 12 patients, posterior and anteromedial approach in four, anterior approach in one. The average operation time and intraoperative blood loss was 129.41±43.87 min and 115.29±104.65 ml. The median follow-up time was 9 months (range, 6 to 15 months). The mean flexion, extension, pronation and supination motion was 138.76±8.67 degrees, 20.00±13.58, 82.94±5.32and 74.12±14.39 respectively at final follow up. The mean MEPS score was 89.76±8.46, including 11 excellent, 3 good and 3 fair result. The mean VAS score was 1.94±0.97. The mean union time of coronoid fractures was 2.77±0.31 months according to the established standard of healing. There were no significant differences in clinical outcomes among groups according to the O'Driscoll classification (P > .05) and ligament repair strategy (P > .05). No patient underwent instability or dislocation of the elbow during follow up. There were two cases with mild ulnar nerve symptoms which recovered totally at follow up. Meanwhile, there were three cases with heterotopic ossification of the elbow.

CONCLUSION

Our findings demonstrated that the SSPS can provide a reliable fixation for the comminuted coronoid fracture with satisfactory clinical outcomes.

Results of arthroscopically assisted reduction and fixation of anteromedial facet coronoid fractures at short-term follow-up

BACKGROUND

Varus posteromedial rotatory instability is a typical pattern of elbow injury that involves fracture of the anteromedial facet (AMF) of the coronoid, as well as injuries to the lateral ligament complex and the posterior bundle of the medial collateral ligament. Some authors support the idea that subtype II AMF coronoid fractures require fixation to restore elbow stability, but this topic is still an issue in the literature. The purpose of this study was to assess the clinical and radiologic outcomes of arthroscopically assisted reduction and internal fixation (ARIF) of AMF fractures.

METHODS

This retrospective single-center trial evaluated consecutive patients who underwent ARIF of isolated subtype II AMF coronoid fractures between 2014 and 2020. At the final follow-up, the patients were examined for elbow range of motion, stability, and pain. Injury and post-treatment radiographs were reviewed to assess fracture healing and heterotopic ossification.

RESULTS

A total of 32 patients (21 male and 11 female patients) with a median age of 47 ± 16 years were included. The average follow-up period was 28 ± 12.4 months. Coronoid process fractures were fixed by cannulated screws in 26 cases (81.25%); in 2 of these cases, additional Kirschner wires were used. Two Kirschner wires were used in 1 case (3.12%), and in the remaining 5 cases (15.62%), osteosuture was used. The lateral ulnar collateral ligament was injured in 27 cases (84.4%) and was always repaired. Other associated lesions were medial collateral ligament injury, osteochondral lesion, and radial head fracture. There were no surgical complications. At the final follow-up, the average Mayo Elbow Performance Score was 98.4 ± 2.7 and the mean Oxford Elbow Score was 47.3 ± 1.4. No cases of nonunion were detected on radiographic assessment.

CONCLUSIONS

Although technically demanding, ARIF has several potential advantages in comparison to open surgery: less scarring, a decreased risk of infection, and less postoperative pain.

Proximal ulna fractures in adults: A review of diagnosis and management

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.