gms | German Medical Science

Objectives/Interrogation: The best surgical protocol to treat fracture dislocation of the elbow with coronoid fracture remains unclear. The purpose of this study was to report the clinical and radiological outcomes of fracture dislocation of the elbow with coronoid fracture.

Methods: This is a retrospective case series of 20 consecutive patients who were treated for fracture dislocation of the elbow with Regan-Morrey Type I/II coronoid fractures between 2008 and 2017. The patients' mean age was 49 years and the mean follow-up period was 12 months. Our surgical protocol included both repair of the lateral collateral ligament (LCL) and fixation or replacement of the radial head first, then repair of the medial collateral ligament (MCL) was additionally performed if the MCL had been confirmed as injured by preoperative MRI and/or intraoperative stress test. Only after that, if the instability remained, was coronoid repair performed. Patients were evaluated both radiographically and with a clinical examination at the final follow-up. Elbow instability was defined as clinical or radiographic evidence at the final follow-up. Outcome measures included elbow range of motion, forearm rotation, elbow stability, and radiographic arthritic changes. Clinical outcomes were assessed with Mayo Elbow Performance Score (MEPS).

Results and Conclusions: All 20 patients had a coronoid fracture, 11 patients had Regan-Morrey Type I fractures and 9 patients had Type II. Among the 20 patients, 12 patients had a terrible triad injury and 8 patients had a fracture dislocation with only coronoid fracture. Repair of the LCL was performed in all 20 patients (100%), and repair of the MCL was performed in 15 patients (75%). Repair of the coronoid fracture was performed in 2 patients (10%) with Type II. Among the 13 patients with a radial head fracture, open reduction and internal fixation in 12 patients and prosthetic replacement in one patient was performed. The mean arc of ulnohumeral motion at the final follow-up was 127° and mean forearm rotation was 155°. None of the patients demonstrated instability postoperatively. Radiographs revealed no arthritic changes. The mean MEPS was 95 points.

In this study, the rate of MCL injury was as high as the rate of LCL injury in fracture dislocation of the elbow. The results suggested that fracture dislocation of the elbow with Regan Type I/II coronoid fractures can be effectively treated without repair of the coronoid, when repair of the LCL/MCL sufficiently restores stability of the elbow.