The role of the coronoid process fracture in the elbow dislocation

Rhee, Yong Girl; Cha, Jae Ryong

Abstract

PURPOSE: To evaluate whether the size of the coronoid process fracture influence on elbow instability, to recognize the requirement of surgery and to report the final results after operation.
MATERIALS AND METHODS
We performed the operative treatment for 10 cases among 17 coronoid process fractures with elbow dislocation from December 1995 to January 1999, and evaluated operative cases. According to Reagan & Morrey classification, 3 cases(30%) belong to type I, 4 cases(40%) type II and 3 cases(30%) type III. The major mode of injury was fall down accident(70%) and most common associated injury was radial head fracture(70%). In all case, the elbow was inevitably subluxated when flexed beyond 45degreesregardless the size of the fragment segment. This lead us to performed the fixation of coronoid process fracture and the reconstruction of the ruptured articular capsule. Two patients who had had recurrent posterolateral instability due to severe capsular damage at initial injury and previous excision of the radial head underwent the total elbow replacement.
RESULTS
According to Mayo elbow performance index, results were graded as excellent in 7 cases(70%), good in 1 cases(10%), and at two case of radial head excision had been performed previously, the results had been graded as poor, but after total elbow replacement they were good. At final results, all of them resulted in more than good. Postoperative range of motion averaged 6 degrees in extension and 128 degrees in forward flexion and there was significantly a tendency for less motion of a forward flexion with more involvement of coronoid fragment.
CONCLUSION
In cases of the elbow dislocation, instability of the elbow is correlated with the severity of the damaged articular capsule and ligament regardless of the size of the coronoid process fracture. The early excision of the fractured radial head should be avoided not to run into total elbow replacement.