Good outcome using anatomically pre-formed buttress plates for anteromedial facet fractures of the coronoid—a retrospective study of twenty-four patients
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Abstract
Purpose
The aims of this retrospective study were to describe the characteristics of anteromedial facet fracture of the coronoid (AMFF) and to determine the outcome following surgery using anatomically pre-formed coronoid buttress plates.
Methods
Twenty-four patients underwent surgery for AMFF, using a pre-formed buttress plate, between 2011 and 2017 (20 men, four women), with a mean age of 47.7 years (range, 19–78 years) and a mean post-operative follow-up of 3.7 years (range, 12–86 months). Fracture classification, injury pattern, accompanying injuries, post-operative range of motion, and revision rate were noted. Post-operative radiographs assessed union, arthritic change, and joint articulation. Joint function was quantified using the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), and the Disabilities of the Arm, Shoulder, and Hand (DASH) scores.
Results
Eleven cases with subtype 2 and 13 cases with a subtype 3 AMFF could be included, of which 15 had an associated rupture of the lateral collateral ligament (LCL) and nine of the medial collateral ligament (MCL). Post-operatively, all cases went to bone union without secondary elbow instability. The mean post-operative range of motion was 125° (range, 90–140°), mean MEPS was 98, mean OES was 43, and mean DASH score was 7. Five patients required repeat surgery within two years due to a limited range of motion; 90% of patients regained their pre-trauma levels of physical activity.
Conclusions
AMFF are challenging injuries, frequently associated with lesions to the collateral ligament complex. Using anatomically pre-formed coronoid plates, excellent functional outcomes can be achieved.
Keywords
Coronoid fracture Anteromedial facet Lateral collateral ligament Outcome Elbow Coronoid InstabilityNotes
Compliance with ethical standards
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
The manuscript has been read and approved by all authors.
Each author believes that the manuscript represents honest work.
Conflict of interest
The authors declare that they have no conflict of interest.
References
- 1.Closkey RF, Goode JR, Kirschenbaum D et al (2000) The role of the coronoid process in elbow stability. A biomechanical analysis of axial loading. J Bone Joint Surg Am 82-A (12):1749–1753CrossRefGoogle Scholar
- 2.Schneeberger AG, Sadowski MM, Jacob HAC (2004) Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow. J Bone Joint Surg Am 86-A(5):975–982CrossRefGoogle Scholar
- 3.Regan W, Morrey B (1989) Fractures of the coronoid process of the ulna. J Bone Joint Surg Am 71(9):1348–1354CrossRefGoogle Scholar
- 4.Jeon IH, Sanchez-Sotelo J, Zhao K et al (2012) The contribution of the coronoid and radial head to the stability of the elbow. J Bone Joint Surg Br 94(1):86–92. https://doi.org/10.1302/0301-620X.94B1.26530 CrossRefPubMedGoogle Scholar
- 5.Leschinger T, Müller LP, Hackl M et al (2017) Concomitant injury of the annular ligament in fractures of the coronoid process and the supinator crest. J Shoulder Elb Surg 26(4):604–610. https://doi.org/10.1016/j.jse.2016.09.029 CrossRefGoogle Scholar
- 6.Wells J, Ablove RH (2008) Coronoid fractures of the elbow. Clin Med Res 6(1):40–44. https://doi.org/10.3121/cmr.2008.753 CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Adams JE, Hoskin TL, Morrey BF et al (2009) Management and outcome of 103 acute fractures of the coronoid process of the ulna. J Bone Joint Surg Br 91(5):632–635. https://doi.org/10.1302/0301-620X.91B5.21755 CrossRefPubMedGoogle Scholar
- 8.O’Driscoll SW, Jupiter JB, King GJ et al (2001) The unstable elbow. Instr Course Lect 50:89–102PubMedGoogle Scholar
- 9.Ring D, Doornberg JN (2007) Fracture of the anteromedial facet of the coronoid process. Surgical technique. J Bone Joint Surg Am 89(Suppl 2 Pt.2):267–283. https://doi.org/10.2106/JBJS.G.00059 CrossRefPubMedGoogle Scholar
- 10.Tashjian RZ, Katarincic JA (2006) Complex elbow instability. J Am Acad Orthop Surg 14(5):278–286CrossRefGoogle Scholar
- 11.Park S-M, Lee JS, Jung JY et al (2015) How should anteromedial coronoid facet fracture be managed? A surgical strategy based on O'Driscoll classification and ligament injury. J Shoulder Elb Surg 24(1):74–82. https://doi.org/10.1016/j.jse.2014.07.010 CrossRefGoogle Scholar
- 12.Lee SK, Kim HY, Kim KJ et al (2012) Coronoid plate fixation of type II and III coronoid process fractures: outcome and prognostic factors. Eur J Orthop Surg Traumatol 22(3):213–219. https://doi.org/10.1007/s00590-011-0825-7 CrossRefGoogle Scholar
- 13.Manidakis N, Sperelakis I, Hackney R et al (2012) Fractures of the ulnar coronoid process. Injury 43(7):989–998. https://doi.org/10.1016/j.injury.2011.08.030 CrossRefPubMedGoogle Scholar
- 14.Zeiders GJ, Patel MK (2008) Management of unstable elbows following complex fracture-dislocations--the “terrible triad” injury. J Bone Joint Surg Am 90(Suppl 4):75–84. https://doi.org/10.2106/JBJS.H.00893 CrossRefPubMedGoogle Scholar
- 15.Pugh DMW, Wild LM, Schemitsch EH et al. (2004) Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg Am 86-A(6): 1122–1130CrossRefGoogle Scholar
- 16.Forthman C, Henket M, Ring DC (2007) Elbow dislocation with intra-articular fracture: the results of operative treatment without repair of the medial collateral ligament. J Hand Surg Am 32(8):1200–1209. https://doi.org/10.1016/j.jhsa.2007.06.019 CrossRefPubMedGoogle Scholar
- 17.Iannuzzi NP, Paez AG, Parks BG et al (2017) Fixation of Regan-Morrey type II coronoid fractures: a comparison of screws and suture lasso technique for resistance to displacement. J Hand Surg Am 42(1):e11–e14. https://doi.org/10.1016/j.jhsa.2016.11.003 CrossRefPubMedGoogle Scholar
- 18.Shen L, Yu X, Zhong B et al (2017) A figure-eight suture loop with Kirschner wires for fixation of anteromedial coronoid process fractures: a case series. Int J Surg Case Rep 33:130–134. https://doi.org/10.1016/j.ijscr.2017.02.016 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Wang P, Zhuang Y, Li Z et al (2017) Lasso plate - an original implant for fixation of type I and II Regan-Morrey coronoid fractures. Orthop Traumatol Surg Res 103(3):447–451. https://doi.org/10.1016/j.otsr.2016.12.017 CrossRefPubMedGoogle Scholar
- 20.Garrigues GE, Wray WH, Lindenhovius ALC et al (2011) Fixation of the coronoid process in elbow fracture-dislocations. J Bone Joint Surg Am 93(20):1873–1881. https://doi.org/10.2106/JBJS.I.01673 CrossRefPubMedGoogle Scholar
- 21.Clarke SE, Lee SY, Raphael JR (2009) Coronoid fixation using suture anchors. Hand (N Y) 4(2):156–160. https://doi.org/10.1007/s11552-008-9142-y CrossRefGoogle Scholar
- 22.Huh J, Krueger CA, Medvecky MJ et al (2013) Medial elbow exposure for coronoid fractures: FCU-split versus over-the-top. J Orthop Trauma 27(12):730–734. https://doi.org/10.1097/BOT.0b013e31828ba91c CrossRefPubMedGoogle Scholar
- 23.O'Driscoll SW, Jupiter JB, Cohen MS et al (2003) Difficult elbow fractures: pearls and pitfalls. Instr Course Lect 52:113–134PubMedGoogle Scholar
- 24.Morrey BF, Sanchez-Sotelo J (2009) The elbow and its disorders, 4th edn. Saunders/Elsevier, PhiladelphiaGoogle Scholar
- 25.Dawson J, Doll H, Boller I et al (2008) The development and validation of a patient-reported questionnaire to assess outcomes of elbow surgery. J Bone Joint Surg Br 90(4):466–473. https://doi.org/10.1302/0301-620X.90B4.20290 CrossRefPubMedGoogle Scholar
- 26.Marquardt J, Schöttker-Königer T, Schäfer A (2016) Validierung der deutschen version des Oxford elbow score: Eine Querschnittsstudie (validation of the German version of the Oxford Elbow Score : a cross-sectional study). Orthopade 45(8):695–700. https://doi.org/10.1007/s00132-016-3292-3 CrossRefPubMedGoogle Scholar
- 27.Germann G, Harth A, Wind G et al (2003) Standardisierung und Validierung der deutschen version 2.0 des “disability of arm, shoulder, hand” (DASH)-Fragebogens zur outcome-Messung an der oberen Extremität (standardisation and validation of the German version 2.0 of the Disability of Arm, Shoulder, Hand (DASH) questionnaire). Unfallchirurg 106(1):13–19. https://doi.org/10.1007/s00113-002-0456-x CrossRefPubMedGoogle Scholar
- 28.Beaton DE, Davis AM, Hudak P et al (2016) The DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure: what do we know about it now? The British Journal of Hand Therapy 6(4):109–118. https://doi.org/10.1177/175899830100600401 CrossRefGoogle Scholar
- 29.Foruria AM, Augustin S, Morrey BF et al (2013) Heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna. J Bone Joint Surg Am 95(10):e66. https://doi.org/10.2106/JBJS.K.01533 CrossRefPubMedGoogle Scholar
- 30.Ring D, Jupiter JB, Zilberfarb J (2002) Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg Am 84-A(4):547–551CrossRefGoogle Scholar
- 31.Egol KA, Immerman I, Paksima N et al (2007) Fracture-dislocation of the elbow functional outcome following treatment with a standardized protocol. Bull NYU Hosp Jt Dis 65(4):263–270PubMedGoogle Scholar
- 32.Lindenhovius ALC, Brouwer KM, Doornberg JN et al (2008) Long-term outcome of operatively treated fracture-dislocations of the olecranon. J Orthop Trauma 22(5):325–331. https://doi.org/10.1097/BOT.0b013e31817283f7 CrossRefPubMedGoogle Scholar
- 33.Doornberg JN, Ring DC (2006) Fracture of the anteromedial facet of the coronoid process. J Bone Joint Surg Am 88(10):2216–2224. https://doi.org/10.2106/JBJS.E.01127 CrossRefPubMedGoogle Scholar
- 34.Hull JR, Owen JR, Fern SE et al (2005) Role of the coronoid process in varus osteoarticular stability of the elbow. J Shoulder Elb Surg 14(4):441–446. https://doi.org/10.1016/j.jse.2004.11.005 CrossRefGoogle Scholar
- 35.Sanchez-Sotelo J, O'Driscoll SW, Morrey BF (2005) Medial oblique compression fracture of the coronoid process of the ulna. J Shoulder Elb Surg 14(1):60–64. https://doi.org/10.1016/j.jse.2004.04.012 CrossRefGoogle Scholar
- 36.Pollock JW, Brownhill J, Ferreira L et al (2009) The effect of anteromedial facet fractures of the coronoid and lateral collateral ligament injury on elbow stability and kinematics. J Bone Joint Surg Am 91(6):1448–1458. https://doi.org/10.2106/JBJS.H.00222 CrossRefPubMedGoogle Scholar
- 37.Ring D, Jupiter JB (2000) Reconstruction of posttraumatic elbow instability. Clin Orthop Relat Res (370):44–56CrossRefGoogle Scholar
- 38.Ring D (2006) Fractures of the coronoid process of the ulna. J Hand Surg Am 31(10):1679–1689. https://doi.org/10.1016/j.jhsa.2006.08.020 CrossRefPubMedGoogle Scholar
- 39.Budoff JE, Meyers DN, Ambrose CG (2011) The comparative stability of screw versus plate versus screw and plate coronoid fixation. J Hand Surg Am 36(2):238–245. https://doi.org/10.1016/j.jhsa.2010.10.022 CrossRefPubMedGoogle Scholar
- 40.Kiene J, Bogun J, Brockhaus N et al (2014) Biomechanical testing of a novel osteosynthesis plate for the ulnar coronoid process. Should Elb 6(3):191–199. https://doi.org/10.1177/1758573214532794 CrossRefGoogle Scholar
- 41.Yang L, Grottkau B, He Z et al (2017) Three dimensional printing technology and materials for treatment of elbow fractures. Int Orthop 41(11):2381–2387. https://doi.org/10.1007/s00264-017-3627-7 CrossRefPubMedGoogle Scholar
- 42.Xu J, Sun S, Li C et al (2014) Effectiveness of anterior approach for treating anteromedial facet fractures of ulnar coronoid process. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 28(7):806–809PubMedGoogle Scholar
- 43.Han S-H, Yoon H-K, Rhee S-Y et al (2013) Anterior approach for fixation of isolated type III coronoid process fracture. Eur J Orthop Surg Traumatol 23(4):395–405. https://doi.org/10.1007/s00590-012-1007-y CrossRefPubMedGoogle Scholar
- 44.Zheng W, Liu J, Song J et al (2018) Risk factors for development of severe post-traumatic elbow stiffness. Int Orthop 42(3):595–600. https://doi.org/10.1007/s00264-017-3657-1 CrossRefPubMedGoogle Scholar
- 45.Cui H-M, Yu Y-L, He Y et al (2018) Management of elbow stiffness after postoperative treatment of terrible triad elbow injury: maintaining mobility and stability using a combined protocol. Int Orthop 42(3):609–618. https://doi.org/10.1007/s00264-017-3721-x CrossRefPubMedGoogle Scholar