Surgical Management of Coronoid Fractures

Abstract

Coronoid fractures occur as part of more complex injuries including other bone fractures (ie, radial head) and/or ligamentous injuries. Diagnostic tests include plain elbow x-rays and should include a computed tomographic scan. Indication for coronoid fixation is based on the fracture size and location, and factors related to the injury pattern and the severity of the instability. Fixation is performed when the fracture is big enough so as to be able to be repaired with solid hardware (screws and plates); small flecks of bone either do not need fixation, or, in cases of severe instability, other methods of stabilization should be chosen to render the elbow stable. Alternatives to fixation include the use of dynamic external fixators. Our preferred method of fixation includes posterior to anterior screw fixation performed open or arthroscopically, and open plate and screw fixation. Screws are used when there is a single big fragment or when one fragment contains the majority of the volume of the fractured coronoid. Arthroscopic fixation is very demanding technically, but much less invasive. Plates are used when coronoid comminution is present, and a buttress effect is needed, and when the sublime tubercle needs fixation. Surgical technique includes specific steps described in this article.