Executive Editor: James Hunter General Editor: Fergal Monsell

Authors: Andrew Howard, Peter Schmittenbecher, Theddy Slongo

Pediatric proximal forearm 21u-M/7 Avulsion of coronoid

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Glossary

General considerations

Small coronoid avulsions do not generally result in elbow instability in the child.

The associated dislocation is treated by 2 weeks of immobilization to allow soft-tissue healing, followed by active assisted range of motion to prevent elbow stiffness.

Large coronoid fragments typically occur in skeletally mature individuals (see adult section). This is often in conjunction with elbow dislocation and can be fixed using sutures or screws.

Coronoid fractures are also a component of multifragmentary proximal ulnar fractures. The coronoid can be approached through the fracture and fixation in this context needs to be considered as part of the overall management stategy. This is considered in open reduction and plate fixation of complete olecranon fractures (21u-M/3.2).

Sling immobilization
Main indication Skill Equipment
Small coronoid avulsion, compliant patient Basic surgical experience, no specialized skills Basic equipment only

Advantages

  • Comfortable
  • Good radiological access
  • Avoidance of joint stiffness
  • Early functional treatment
Cast immobilization
Main indication Skill Equipment
Small coronoid avulsion, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only

Contraindications

  • Severe swelling
  • Skin lesions

Advantages

  • Cannot be removed by patient/parent

Disadvantages

  • Loss of x-ray definition
  • Joint stiffness
Splint immobilization
Main indication Skill Equipment
Small coronoid avulsion, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only

Supporting indications

  • Swelling and pain
  • Skin lesions

Advantages

  • Removable for skin care
  • Removable if pain or neurovascular problems develop
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2019-08-28