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Objective: The study aims to explain whether or not minimal invasive surgery (MIS) would be feasible in elbow fracture–dislocation with coronoid process fracture. Methods: At Taipei Veterans General Hospital, patients who had elbow dislocations with coronoid process fractures underwent a single surgeon’s MIS techniques which included the fluoroscopy-guided ulnar anteromedial (FGUAM) approach in the stage of reducing the coronoid process. When there is a proximal ulnar fracture, the posterior incision should be necessary, followed by the incision over the lateral or medial elbow for treating radial fractures or ligament injuries. Results: The Flow Diagram for approach recommendation was established on the basis of defining MIS as that which does not include cross-plane dissection. The importance of anterior rigid fixation for the coronoid process was also emphasized. Conclusions: MIS can be achieved by multiple limited surgical incisions. Although the posterior extensile approach is necessary in situations of ulnar metaphysis or ligament avulsion fracture, the FGUAM approach decreases the cross-plane dissection.

Background The fracture of the coronoid process of mandible is one of the rarest fractures seen and the paucity of literature on the topic reflects the same. Despite the low incidence rate, the complications maybe grave which is why proper management is important. The treatment is controversial also because of the absence of standardized treatment protocol. This systematic review aims to compare the outcome of various treatment modalities available. Methods Registered under PROSPERO: CRD42020200700. Systematic research was conducted across databases like PubMed, Google Scholar, Pro Quest, Wiley Online. All clinical studies done till January 2021 which included participants above 14 years of age were included. Case reports, case series and studies not mentioning the treatment plan were excluded. The studies were shortlisted by the authors based on the eligibility criteria. Risk of bias was assessed using the MINORS tool and JBI checklist. Results A total of five studies were included. Four were retrospective studies and one was a retrospective case-controlled study. Two studies reported high, two moderate and one low risk of bias. Various treatment modalities were reported for the management of coronoid process fractures including conservative management, ORIF and coronoidectomy. Most authors preferred conservative management in asymptomatic cases and surgical management in symptomatic cases. Discussion No randomized control trials were found on the topic. Majority of the articles were case reports. Conservative management was preferred in minimally displaced fractures of coronoid process. However, in presence of displaced coronoid process fractures causing impediment of mandibular function surgical management is preferred.

Coronoid fractures are rarely isolated and are much more frequently associated with other osseous or ligamentous structures injuries. On the basis of the coronoid fracture patterns, described by the O’Driscoll classification, it is possible to recognize three main patterns of injury that differ on traumatic mechanism and on associated lesions: posterolateral rotatory instability, posteromedial rotatory instability, and axial load injuries. The management of coronoid fractures is challenging and varies according to characteristics of the fracture, associated lesions, and amount of elbow instability. In general, operative treatment is indicated in every case the fracture is at least 50% of the whole coronoid, whether the sublime tubercle is involved, and whether the ulno-humeral joint is not perfectly reduced. In conclusion, the correct management of the coronoid, especially in the setting of complex elbow instability, represents a predictive factor for patient outcomes and functional results. The stability of the elbow, rather than the size of the coronoid fragment, is the main parameter for surgical indication, aimed to fix the coronoid and/or repair the associated lesions.

Monteggia injuries are rare, but severe injuries of the elbow including various injury patterns. Treatment of these injuries is still topic of debate and strategies differ widely. In this systematic review on Monteggia injuries in adults, we aimed to clarify the incidence of different injury patterns within Monteggia injuries, investigate the main reasons leading to revision surgery and explore which surgical treatments should be favored to achieve satisfactory clinical results.We initially identified 182 publications and ultimately included 17 retrospective studies comprising 651 cases. All patients were classified using the Bado classification, leading to 30.5% Bado type I fractures, 60.4% type II fractures, 5.1% type III and 3.1% type IV fractures. Mean revision rate was 23%. Ulna non-union (28%) and limited range-of-motion (22%) are the main reasons for revision surgery. Meta-analysis shows a trend toward the use of locking plates for ulna fixation which may lead to less revision surgery and fewer ulna non-unions. Further biomechanical and clinical research is necessary to clarify the role of radial head surgery.

IntroductionAmong the few techniques described for the treatment of coronoid fractures, osteosynthesis techniques include screw osteosynthesis from anterior to posterior (AP) or from posterior to anterior (PA) and plate osteosynthesis. The aim of this study was to test the biomechanical stability of screw osteosynthesis and plate osteosynthesis using anatomical plates in coronoid process fractures.Materials and methodsOn a total of 25 biomechanical synthetical ulnae, a coronoid shear fracture including 70% of the coronoid height was simulated. Osteosynthesis was then performed using two 2.7 mm screws from anterior, posterior and with use of three different anatomical plates of the coronoid process. For the biomechanical testing, axial load was applied to the fragment with 1000 cycles from 5 to 250 N, load to failure and load at 100 µm displacement. Displacements were measured using a point-based three-dimensional motion analysis system.ResultsOsteosynthesis using the PA-screw showed significant more displacement during cyclic loading compared with all other osteosyntheses (0.99 mm), whereas AP-screw showed the smallest displacement (0.10 mm) during cyclic loading. The PA-screw technique showed a significant lower load to failure compared to all other osteosynthesis with the highest load in AP-screw osteosynthesis. The load for 100 µm displacement was the smallest in PA-screw with a significant difference to the AP-screw and one plate osteosynthesis.ConclusionOsteosynthesis of large coronoid shear fractures with two small-fragment screws from anterior allows stable fixation that is not inferior to anterior plate osteosynthesis and might be an alternative in specific fracture types. Posterior screw fixation was found as the weakest fixation method.Level of evidenceBasic science study

Purpose The purpose of this study is to compare the effect of buttress plate and cannulated screw in the treatment of anteromedial coronoid fracture with posteromedial rotatory instability (PMRI). Methods We retrospectively evaluated patients who were diagnosed with O’Driscoll type 2 fractures combined with elbow posteromedial rotatory instability and underwent surgery for anteromedial coronoid fracture between August 2014 and March 2019. They were divided into buttress plate ( n =16) and cannulated screw ( n =11) groups. The elbow range of motion, visual analog scale (VAS), Mayo elbow performance score (MEPS), and disabilities of the arm, shoulder, and hand score (DASH) were used for clinical outcome assessment. Result There were no significant differences in clinical outcomes. However, the surgical time was significantly shorter in cannulated screw group (85.45±4.156) compared to the buttress plate group (93.81±8.863, P =0.008), and the surgical time was associated with internal fixation ( P =0.008). Conclusion Although there was selection of cases in that small fragments were treated with buttress plate and large fragments with cannulated screw, the buttress plate and cannulated screw have comparable functional outcomes on fixation of the anteromedial coronoid fracture with elbow PMRI. The fixation of the anteromedial coronoid fracture with large fragments using the cannulated screw has a shorter operation time.

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.

Objective The objective of this study was to evaluate the effectiveness of suture lasso combined with lateral plate in comminuted transolecranon fracture-dislocations of the elbow. Method We retrospectively reviewed 13 patients with comminuted transolecranon fracture-dislocations of the elbow. Our study included 6 males and 7 females with a mean of age 54.3 years. All the patients had comminuted fracture of proximal ulna and coronoid fracture of Regan-Morrey type II/III. Among them, 4 cases were combined with radial head fractures. The patients were treated with open reduction and internal fixation with suture lasso combined with lateral plate based on the traditional mode. Results The mean follow-up was 15.7 ± 5.8 months (range 12–33 months). During the follow-up period, the fracture and joint alignment were good, and there was no loosening of internal fixation. X-ray films showed that the fracture healing time was 3–6 months, with an average of 3.8 ± 0.9 months. Mild postoperative heterotopic ossification was observed in 2 cases. There was 1 case of poor wound healing and 1 case of ulnar nerve stimulation. At the last follow-up, the average Mayo elbow function score and Broberg-Morrey score were 91.5 ± 9.2 and 94.7 ± 6.5 points respectively. The result was classified as excellent in 9, good in 3, and fair in 1 patient. The excellent and good rate was 92.3%. Conclusions Our study suggested that suture lasso combined with lateral plate based on the traditional internal fixation mode was highly effective for the treatment of transolecranon fracture-dislocations of the elbow. Especially for the patient with comminuted proximal ulna, the restoration and fixation of coronoid process were quite important to increase the stability of the elbow joint and lead to good clinical efficacy.

Introduction Dislocations of the elbow are the second most frequent upper-body injury after shoulder dislocations, comprising 11–28% of all elbow injuries. Complex elbow dislocations pose challenging management due to the involvement of critical stabilizing structures. This study aimed to investigate functional and subjective outcomes (MEPS, DASH, Oxford score) in 44 patients with complex elbow dislocations who underwent surgery between 2018 and 2020, with subgroup analysis focusing on gender and age differences. Material and methods A retrospective analysis was conducted on patients treated at C.T.O. Hospital, Turin, for complex elbow dislocations between January 2018 and December 2020. Surgical approaches included radial head synthesis, coronoid fixation, ligamentous repair, and ulnar nerve management. Postoperatively, patients followed a standardized or individualized program. Data analysis involved t-tests to assess score differences between subgroups. Results Among the 44 analyzed patients, the mean age was 48 years, and the mean follow-up time was 29 months. Various types of complex dislocations were identified, with radial head and coronoid fractures classified accordingly. Surgical approaches included multiple methods of reduction and synthesis. While most patients adhered to postoperative programs, subsequent reoperations were conducted in 11% of cases. Scores did not significantly differ between genders, although a trend toward better DASH scores in males was observed. Younger patients showed better, though not statistically significant, outcomes in mobility and functional measures. Conclusion This study underscores the importance of pre-operative assessment for positive surgical outcomes in complex elbow dislocations. Additionally, findings suggest that younger age may correlate with slightly better functional outcomes. Despite limitations such as retrospective design and sample size, the study enhances our understanding of complex dislocation outcomes and provides valuable insights for future interventions.

The purpose of this systematic review is to summarize the current literature on conservative and surgical management of isolated O'Driscoll II coronoid fracture. Systematic review. We systematically searched Medline, Embase, Google Scholar, and Web of Science databases for published studies by complying with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using the keywords “isolated coronoid fracture,” “O'Driscoll type 2 coronoid fracture,” “anteromedial coronoid fracture,” “anteromedial facet coronoid fracture,” “posteromedial rotatory instability,” and “varus posteromedial rotatory instability.” Patients were divided into conservative treatment and surgical treatment groups. Oxford Centre for Evidence-Based Medicine and Methodological Index for Non-Randomized Studies were assessed to determine each article’s quality. The primary outcomes of the present reviews were the Mayo elbow performance score (MEPS) and the disabilities of the arm, shoulder, and hand (DASH) score, and the secondary outcomes were associated with complications and reoperations. Eligible trials were independently chosen by two review authors, and a third reviewer resolved all disagreements. The search yielded 458 records, among which 446 articles were of relevance, and 12 were included. In the final review, 138 patients were evaluated—98 (71%) who received surgical treatment and 40 (29%) who received conservative treatment. The mean MEPS score and the DASH score of surgical treatment were 91 and 8, respectively; 69.8% of patients had excellent scores, and 27.0% had good scores. The mean MEPS score and the DASH score of conservative treatment were 92 and 12, respectively; 70.6% of patients had excellent scores, and 23.5% had good scores. In select cases, conservative treatment can achieve good results in the treatment of isolated O'Driscoll II coronoid fracture when a stricter indication is followed. However, there is insufficient evidence to recommend the appropriate treatment for a particular fracture subtype, and there is a need for more high-quality randomized controlled trials to determine which treatment is superior. •A systematic review was performed on management of isolated O'Driscoll II coronoid fracture.•Low-to-moderate quality evidence shows variability in guide clinical decisions.•Isolated O'Driscoll II coronoid fracture can be conservatively treated.•In select cases, conservative treatment can achieve the same results as surgery.