Treatment of ulnar coronoid process fracture via a modified anteromedial approach_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Gang , ZHANG Lecheng ,  ZHANG Yuelei

Department of Orthopaedic Trauma, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230000, P.R.China;

Corresponding author：

ZHANG Yuelei, Email: orthozhang5233@163.com

Keywords：

Ulnar coronoid process fracture; anteromedial approach; anteromedial facet of coronoid process

DOI：

10.7507/1002-1892.201912012

Video：

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Objective To investigate the effectiveness of a modified anteromedial approach in the treatment of ulnar coronoid process fracture.Methods Between February 2017 and July 2018, 15 patients with ulna coronoid process fracture were reviewed. There were 9 males and 6 females, with an average age of 42.3 years (range, 24-60 years). The causes of injury included falling in 10 cases and traffic accidents in 5 cases, all cases were closed injury. According to the O’Driscoll classification, there were 4 cases of type Ⅰ, 6 cases of type Ⅱ, and 5 cases of type Ⅲ. The time from injury to operation was 2-8 days (mean, 3.7 days). All fractures were treated via a modified anteromedial approach between the pronator teres and the flexor carpi radialis plus with partial incision of flexor tendon aponeurosis. The fracture healing, muscle strength of forearm, postoperative complications were observed. At last follow-up, the elbow mobility were measured, the function of elbow was evaluated by Mayo elbow performance score (MEPS).Results All cases were followed up 10-18 months (mean, 13.3 months). Fracture union was achieved in all patients with a mean time of 10 weeks (range, 8-14 weeks). No obvious decrease of hand grip strength, nerve injury, and infection occurred. One patient had slight heterotopic ossification without special treatment. At last follow-up, all patients had stable elbows with good flexion-extension and varus-valgus stability, the mean flexion was 123.3° (range, 100°-140°), mean extension loss compared with that before operation was 6.7° (range, 0°-20°), mean pronation was 76.0° (range, 60°-85°), and mean supination was 75.8° (range, 55°-90°). The MEPS score was 65-100 (mean, 90.3) with the result of excellent in 10 cases, good in 4 cases, and fair in 1 case.Conclusion The treatment of ulnar coronoid process fracture via the modified anteromedial approach provides excellent exposure, minimal invasion, fewer complications, and satisfactory prognosis, which is conducive to elbow joint function recovery.

Citation： WANG Gang, ZHANG Lecheng, ZHANG Yuelei. Treatment of ulnar coronoid process fracture via a modified anteromedial approach. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(7): 826-830. doi: 10.7507/1002-1892.201912012 Copy

1.	Reichel LM, Milam GS, Hillin CD, et al. Osteology of the coronoid process with clinical correlation to coronoid fractures in terrible triad injuries. J Shoulder Elbow Surg, 2013, 22(3): 323-328.
2.	Pollock JW, Brownhill J, Ferreira L, et al. The effect of anteromedial facet fractures of the coronoid and lateral collateral ligament injury on elbow stability and kinematics. J Bone Joint Surg (Am), 2009, 91(6): 1448-1458.
3.	Garrigues GE, Wray WH 3rd, Lindenhovius AL, et al. Fixation of the coronoid process in elbow fracture-dislocations. J Bone Joint Surg (Am), 2011, 93(20): 1873-1881.
4.	O’Driscoll SW, Jupiter JB, Cohen MS, et al. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect, 2003, 52: 113-134.
5.	董洪先, 黄富国. 尺骨冠状突前内侧骨折与肘关节外侧副韧带复合体损伤对肘关节后内侧旋转稳定性影响的生物力学研究. 中国修复重建外科杂志, 2017, 31(2): 176-179.
6.	Park SM, Lee JS, Jung JY, et al. How should anteromedial coronoid facet fracture be managed? A surgical strategy based on O’Driscoll classification and ligament injury. J Shoulder Elbow Surg, 2015, 24(1): 74-82.
7.	Rhyou IH, Kim KC, Lee JH, et al. Strategic approach to O’Driscoll type 2 anteromedial coronoid facet fracture. J Shoulder Elbow Surg, 2014, 23(7): 924-932.
8.	Pierrart J, Bégué T, Mansat P, et al. Terrible triad of the elbow: treatment protocol and outcome in a series of eighteen cases. Injury, 2015, 46(Suppl 1): S8-S12.
9.	Mathew PK, Athwal GS, King GJ. Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg, 2009, 17(3): 137-151.
10.	Hotchkiss RN, Kasparyan GN. The medial “over the top” approach to the elbow. Techniques in Orthopaedics, 2000, 15(2): 105-112.
11.	Ring D. Fractures of the coronoid process of the ulna. J Hand Surg (Am), 2006, 31(10): 1679-1689.
12.	Yang X, Chang W, Chen W, et al. A novel anterior approach for the fixation of ulnar coronoid process fractures. Orthop Traumatol Surg Res, 2017, 103(6): 899-904.
13.	Zhang C, Zhong B, Luo CF. Treatment strategy of terrible triad of the elbow: experience in Shanghai 6th People’s Hospital. Injury, 2014, 45(6): 942-948.
14.	Zhou C, Xu J, Lin J, et al. Comparison of a single approach versus double approaches for the treatment of terrible traid of elbow-A retrospective study. Int J Surg, 2018, 51: 49-55.
15.	Lor KKH, Toon DH, Wee ATH. Buttress plate fixation of coronoid process fractures via a medial approach. Chin J Traumatol, 2019, 22(5): 255-260.
16.	Huh J, Krueger CA, Medvecky MJ, et al. Medial elbow exposure for coronoid fractures: FCU-split versus over-the-top. J Orthop Trauma, 2013, 27(12): 730-734.
17.	Shen JJ, Qiu QM, Gao YB, et al. Direct anterior approach for mini plate fixation of Regan-Morrey type Ⅱ comminuted ulnar coronoid process fracture. J Orthop Surg (Hong Kong), 2019, 27(1): 2309499018825223.
18.	杨冬松, 陈宏峰, 郭前进, 等. 改良肘关节前内侧入路治疗尺骨冠状突骨折. 中国修复重建外科杂志, 2017, 31(12): 1409-1413.
19.	Chen H, Wang Z, Li J, et al. Treatment of the coronoid process fractures with anteromedial approach: A case report. Int J Clin Exp Med, 2015, 8(10): 19607-19611.
20.	杨方玖, 周运栏, 薛黔. 正中神经前臂分支与旋前圆肌的关系以及旋前圆肌肌内神经分布研究. 实用医学杂志, 2010, 26(1): 12-14.
21.	Sukegawa K, Suzuki T, Ogawa Y, et al. Anatomical cadaver study of the hotchkiss over-the-top approach for exposing the anteromedial facet of the ulnar coronoid process: critical measurements and implications for protecting the median nerve. J Hand Surg (Am), 2016, 41(8): 819-823.
22.	贺韬, 张云辉, 李亘, 等. 肘关节前内侧入路治疗冠状突骨折的解剖学研究及临床应用. 中华创伤骨科杂志, 2017, 19(7): 559-565.
23.	Toros T, Ozaksar K, Sügün TS, et al. The effect of medial side repair in terrible triad injury of the elbow. Acta Orthop Traumatol Turc, 2012, 46(2): 96-101.

1. Reichel LM, Milam GS, Hillin CD, et al. Osteology of the coronoid process with clinical correlation to coronoid fractures in terrible triad injuries. J Shoulder Elbow Surg, 2013, 22(3): 323-328.
2. Pollock JW, Brownhill J, Ferreira L, et al. The effect of anteromedial facet fractures of the coronoid and lateral collateral ligament injury on elbow stability and kinematics. J Bone Joint Surg (Am), 2009, 91(6): 1448-1458.
3. Garrigues GE, Wray WH 3rd, Lindenhovius AL, et al. Fixation of the coronoid process in elbow fracture-dislocations. J Bone Joint Surg (Am), 2011, 93(20): 1873-1881.
4. O’Driscoll SW, Jupiter JB, Cohen MS, et al. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect, 2003, 52: 113-134.
5. 董洪先, 黄富国. 尺骨冠状突前内侧骨折与肘关节外侧副韧带复合体损伤对肘关节后内侧旋转稳定性影响的生物力学研究. 中国修复重建外科杂志, 2017, 31(2): 176-179.
6. Park SM, Lee JS, Jung JY, et al. How should anteromedial coronoid facet fracture be managed? A surgical strategy based on O’Driscoll classification and ligament injury. J Shoulder Elbow Surg, 2015, 24(1): 74-82.
7. Rhyou IH, Kim KC, Lee JH, et al. Strategic approach to O’Driscoll type 2 anteromedial coronoid facet fracture. J Shoulder Elbow Surg, 2014, 23(7): 924-932.
8. Pierrart J, Bégué T, Mansat P, et al. Terrible triad of the elbow: treatment protocol and outcome in a series of eighteen cases. Injury, 2015, 46(Suppl 1): S8-S12.
9. Mathew PK, Athwal GS, King GJ. Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg, 2009, 17(3): 137-151.
10. Hotchkiss RN, Kasparyan GN. The medial “over the top” approach to the elbow. Techniques in Orthopaedics, 2000, 15(2): 105-112.
11. Ring D. Fractures of the coronoid process of the ulna. J Hand Surg (Am), 2006, 31(10): 1679-1689.
12. Yang X, Chang W, Chen W, et al. A novel anterior approach for the fixation of ulnar coronoid process fractures. Orthop Traumatol Surg Res, 2017, 103(6): 899-904.
13. Zhang C, Zhong B, Luo CF. Treatment strategy of terrible triad of the elbow: experience in Shanghai 6th People’s Hospital. Injury, 2014, 45(6): 942-948.
14. Zhou C, Xu J, Lin J, et al. Comparison of a single approach versus double approaches for the treatment of terrible traid of elbow-A retrospective study. Int J Surg, 2018, 51: 49-55.
15. Lor KKH, Toon DH, Wee ATH. Buttress plate fixation of coronoid process fractures via a medial approach. Chin J Traumatol, 2019, 22(5): 255-260.
16. Huh J, Krueger CA, Medvecky MJ, et al. Medial elbow exposure for coronoid fractures: FCU-split versus over-the-top. J Orthop Trauma, 2013, 27(12): 730-734.
17. Shen JJ, Qiu QM, Gao YB, et al. Direct anterior approach for mini plate fixation of Regan-Morrey type Ⅱ comminuted ulnar coronoid process fracture. J Orthop Surg (Hong Kong), 2019, 27(1): 2309499018825223.
18. 杨冬松, 陈宏峰, 郭前进, 等. 改良肘关节前内侧入路治疗尺骨冠状突骨折. 中国修复重建外科杂志, 2017, 31(12): 1409-1413.
19. Chen H, Wang Z, Li J, et al. Treatment of the coronoid process fractures with anteromedial approach: A case report. Int J Clin Exp Med, 2015, 8(10): 19607-19611.
20. 杨方玖, 周运栏, 薛黔. 正中神经前臂分支与旋前圆肌的关系以及旋前圆肌肌内神经分布研究. 实用医学杂志, 2010, 26(1): 12-14.
21. Sukegawa K, Suzuki T, Ogawa Y, et al. Anatomical cadaver study of the hotchkiss over-the-top approach for exposing the anteromedial facet of the ulnar coronoid process: critical measurements and implications for protecting the median nerve. J Hand Surg (Am), 2016, 41(8): 819-823.
22. 贺韬, 张云辉, 李亘, 等. 肘关节前内侧入路治疗冠状突骨折的解剖学研究及临床应用. 中华创伤骨科杂志, 2017, 19(7): 559-565.
23. Toros T, Ozaksar K, Sügün TS, et al. The effect of medial side repair in terrible triad injury of the elbow. Acta Orthop Traumatol Turc, 2012, 46(2): 96-101.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of ulnar coronoid process fracture via a modified anteromedial approach

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