Fixation of the Coronoid Process in Elbow Fracture-Dislocations

• Published in: Journal of bone and joint surgery. American volume Vol. 93; no. 20; pp. 1873 - 1881
• Main Authors: Garrigues, Grant E, Wray, Walter H, Lindenhovius, Anneluuk L.C, Ring, David C, Ruch, David S
• Format: Journal Article
• Language: English
• Published: Boston, MA Copyright by The Journal of Bone and Joint Surgery, Incorporated 19-10-2011; Journal of Bone and Joint Surgery Incorporated
• Subjects: Adult; Aged; Biological and medical sciences; Bone Screws; Cohort Studies; Diseases of the osteoarticular system; Elbow Joint - injuries; Elbow Joint - surgery; Female; Follow-Up Studies; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Fracture Healing - physiology; Humans; Injuries of the limb. Injuries of the spine; Injury Severity Score; Intra-Articular Fractures - diagnosis; Intra-Articular Fractures - surgery; Joint Dislocations - diagnosis; Joint Dislocations - surgery; Male; Medical sciences; Middle Aged; Multiple Trauma - diagnosis; Multiple Trauma - surgery; Orthopedic surgery; Radius Fractures - surgery; Range of Motion, Articular - physiology; Recovery of Function; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Suture Anchors; Traumas. Diseases due to physical agents; Young Adult; Fracture dislocation; Orthopedic surgery; Fixation; Treatment; Diseases of the osteoarticular system; Coronoid process; Bone; Elbow
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.I.01673

BACKGROUND:Terrible triad injuries consist of a posterior dislocation of the elbow, a coronoid fracture, and a radial head fracture. The coronoid plays a pivotal role as an anterior buttress, yet the optimal management of the coronoid fracture remains unknown. We hypothesize that suture lasso fixation of the coronoid fracture leads to fewer complications and improved outcomes compared with screw or suture anchor fixation techniques.
METHODS:A retrospective chart review performed at three tertiary care centers identified forty consecutive patients treated for terrible triad injuries of the elbow with a minimum follow-up of eighteen months (mean, twenty-four months; range, eighteen to fifty-three months). All patients were managed with a standard approach consisting of(1) repair or replacement of the radial head; (2) repair of the lateral ulnar collateral ligament (LUCL) of the elbow; and (3) repair of the coronoid fracture with one of two techniquesGroup I (n = 28) consisted of the “lasso” technique and Group II (n = 12) consisted of open reduction and internal fixation (ORIF) with screws or suture anchors.
RESULTS:For the study population, the mean postoperative arc of elbow motion was 115° (range, 75° to 140°), the average Disabilities of the Arm, Shoulder and Hand (DASH) score was 16 (range, 0 to 43), and the average Broberg-Morrey score was 90 (range, 64 to 100). For repair of the coronoid fracture, the suture lasso technique was more stable than the other techniques intraoperatively, both before (p < 0.05) and after (p < 0.05) LUCL repair, and at the final follow-up (p < 0.05). ORIF was associated with a higher prevalence of implant failure (p < 0.05), and suture anchors were associated with a higher prevalence of malunion and nonunion (p < 0.05).
CONCLUSIONS:For terrible triad injuries, greater stability with fewer complications was achieved with use of the suture lasso technique for coronoid fracture fixation.
LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.