Executive Editor: Peter Trafton, Michael Baumgaertner

Authors: Peter Kloen, David Ring

Proximal forearm Varus posteromedial rotational instability

back to skeleton

Glossary

1 Introduction top

The severity of these injuries should not be underestimated. Although the radiographic findings can be subtle, the combination of medial and lateral injury can lead to recurrent elbow instability.


Principles

Fractures of the anteromedial facet of the coronoid are usually associated with LCL injuries and subluxation, but not dislocation of the elbow. If the trochlea subluxates into the coronoid defect, the elbow will become arthritic.

Compliant patients with small fractures and a congruent elbow joint can be treated nonoperatively. If there is any sign of subluxation, the bias should be towards surgical repair: Buttress plate fixation of the coronoid fracture and reattachment of the LCL to the lateral condyle.


Variations of the injury

  • In some variations of these injuries the olecranon is fractured.
  • Some elbow dislocations are associated with small anteromedial facet fractures. These can be very unstable elbow dislocations and the role fixation of the coronoid vs external fixation of the elbow is unclear.

2 Positioning top

The patient is placed in a supine position with the arm on the table. If available, a sterile tourniquet may be advantageous as it increases the surgical field.

3 Approaches top

Either a medial or posterior skin incision can be used.

The best exposure of the anteromedial facet of the coronoid is to split the flexor carpi ulnaris, which fully exposes the ulnar nerve.

  • Posterior midline approach
  • Medial: Overt the top
  • Medial: Taylor and Schram
  • Medial: FCU Split
  • 4 Fixation top

    Sequence of repair

    Whether to fix the bone or ligament first is surgeon’s choice.


    enlarge

    Coronoid repair

    Most fractures are fixed with a buttress plate. Smaller fragments can be secured with a suture lasso.


    enlarge

    Ligament repair

    The LCL can be repaired with either sutures or anchors depending on the pathoanatomy and surgeon's preference.

    5 Final assessment top

    Check for joint instability or any sign of residual subluxation.

    v2.0 2018-04-30