The Journal of Bone and Joint Surgery (American). 2007;89:267-283.
doi:10.2106/JBJS.G.00059
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Fracture of the Anteromedial Facet of the Coronoid Process

Surgical Technique

David Ring, MD, PhD1 and Job N. Doornberg, PhD1

1 Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center Suite 2100, 55 Fruit Street, Boston, MA 02114. E-mail address for D. Ring: dring{at}partners.org

Investigation performed at the Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 88-A, pp. 2216-24, October 2006

DISCLOSURE: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the AO Foundation, Small Bone Innovations, Smith and Nephew, Wright Medical Technology, Joint Active Systems, and Biomet and less than $10,000 from the Stichting Anna Fonds and the Stichting Wetenschappelijk Onderzoek Orthopaedische Chirurgie. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The line drawings in this article are the work of Joanne Haderer Müller of Haderer & Müller (biomedart{at}haderermuller.com).

BACKGROUND: Fracture of the anteromedial facet of the coronoid was recently recognized as a distinct type of coronoid fracture resulting from a varus posteromedial rotational injury force. Very few reports are available to help guide the management of these injuries.

METHODS: Eighteen patients with a fracture of the anteromedial facet of the coronoid process were treated over a six-year period. Twelve patients were treated for the acute fracture, and six were managed after initial treatment elsewhere. All but three patients (two with concomitant fracture of the olecranon and one with a second fracture at the base of the coronoid) had avulsion of the origin of the lateral collateral ligament complex from the lateral epicondyle. The initial treatment was operative in fifteen patients and nonoperative in three. The coronoid fracture was secured with a plate applied to the medial surface of the coronoid in nine patients, a screw in one patient, and sutures in one patient. It was not repaired in the remaining seven patients.

RESULTS: At the final evaluation, an average of twenty-six months after the injury, six patients had malalignment of the anteromedial facet of the coronoid with varus subluxation of the elbow, which was due to the fact that the fracture had not been specifically treated in four patients and to loss of fracture fixation in two patients. All six had development of arthrosis and a fair or poor result according to the system of Broberg and Morrey. The remaining twelve patients had good or excellent elbow function.

CONCLUSIONS: Anteromedial fractures of the coronoid are associated with either subluxation or complete dislocation of the elbow in most patients. Secure fixation of the coronoid fracture usually restores good elbow function.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

ORIGINAL ABSTRACT CITATION: "Fracture of the Anteromedial Facet of the Coronoid Process" (2006;88:2216-24).


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Related articles in JBJS:

Fracture of the Anteromedial Facet of the Coronoid Process
Job N. Doornberg and David C. Ring
JBJS 2006 88: 2216-2224. [Abstract] [Full Text]