This retrospective review of 18 patients with a fracture of the anteromedial facet of the coronoid process were treated over a six-year period. Thirteen fractures were associated with varus subluxation of the joint and five had complete posterior dislocation of the elbow. Among the patients with subluxation, seven had an associated avulsion of the lateral collateral ligament from the lateral epicondyle, four had a fracture of the olecranon, one had a simple fracture of the coronoid alone and one had an associated fracture of the medial lip of the trochlea. Among the patients with a complete dislocation, two had a very small anteromedial facet coronoid fractures and three had an associated fracture of the radial head (terrible triad injury). The coronoid was repaired with a pre-contoured plate in seven patients, 3.0 mm cannulated screws in three patients, a 2.0 mm T-plate in two patients and sutures in one patient. The coronoid was not repaired in two patients with an elbow dislocation. Of the 17 patients available for follow-up at 26 months (range, 4 to 57 months), the average arc of elbow motion was 116 degrees (range, 30 to 145 degrees) with average flexion contracture of 17 degrees. Of the 12 patients initially treated by the authors, two patients experienced complications leading to additional surgery within the first two weeks. One had a deep infection which developed into chronic osteomyelitis and subsequently a failed elbow arthrodesis, and one patient had a recurrent dislocation of the elbow with wound separation and a colonized hematoma. Two patients had postoperative ulnar neuropathy with one having persistent symptoms two years after the injury. One patient required removal of the proximal ulnar plate, and one patient developed a proximal radioulnar synostosis and subsequently underwent an elbow contracture release. Seven of nine patients felt to have limited or inadequate treatment of the coronoid fracture had subsequent problems with elbow stability.
This study further defines injury patterns associated with anteromedial facet fractures of the coronoid process and their potential long-term sequelae with inadequate or insufficient treatment. That is, inadequate treatment may have a very high risk of persistent instability or joint subluxation and subsequent arthrosis. A computerized tomographic scan can more optimally define the anatomy of this fracture to allow for proper treatment. This study identified a commonly associated tear of the lateral collateral ligament from the lateral epicondyle (except in patients who have an associated olecranon fracture). In addition, complete elbow dislocations may have injuries of both the lateral and medial collateral ligaments with these anteromedial facet fractures and should be aggressively diagnosed and treated.
Elbow, Fracture, Dislocation, Coronoid, Anteromedial, Facet
Journal of Bone and Joint Surgery