This is a retrospective review of 6 patients who underwent reconstruction of the coronoid process using an osteochondral bone graft. All of these injuries were fractures of the coronoid, radial head, and collateral ligament disruption (terrible triad injuries). All surgeries were reconstructive in nature, at least 6 months following the initial injury. Results demonstrate complete resorption of the graft in 1 patient with severe osteoarthritis of the elbow. Of the remaining 5 patients, 1 had an excellent, 2 good, 1 fair, and 2 poor results.
Structural bone graft may be a useful option in elbows with a deficient coronoid process and instability. However, the outcome is unpredictable. The anterior buttress effect of the coronoid on the humeral trochlea involves not only the central coronoid tip but the very important medial facet of the coronoid, which spans all the way over to the medial joint line. This anatomy is difficult to reconstruct with a free bone graft. The mixed results reported are most likely secondary to the difficulties encountered with reconstruction and rehabilitation of the unstable elbow including the collateral ligaments and radial head.
Journal of Shoulder and Elbow