EFFECTIVENESS OF ANTERIOR APPROACH FOR TREATING ANTEROMEDIAL FACET FRACTURES OF ULNAR CORONOID PROCESS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XUJian , SUNShengxuan , LICheng ,  ZHOUHaibin , DONGQirong

Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215004, P. R. China;

Corresponding author：

ZHOUHaibin, Email: szzhouhaibin@gmail.com

Keywords：

Anteromedial facet fracture of ulnar coronoid process; Anterior approach; Non-absorbable suture; Suture anchor; Internal fixation

DOI：

10.7507/1002-1892.20140179

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Objective To explore the effectiveness of non-absorbable suture or suture anchor fixation by anterior approach in the treatment of anteromedial facet fractures of the ulnar coronoid process. Methods Between February 2007 and February 2012,16 cases of anteromedial facet fractures of the ulnar coronoid process were treated with operation.There were 9 males and 7 females,aged 20-80 years (mean,43.5 years).The causes of injury were traffic accident injury in 7 cases,tumble injury in 5 cases,and falling injury from height in 4 cases.The time from injury to operation was 6.8 days on average (range,2-8 days).All cases had closed fractures.According to O'Driscoll classification,there were 4 cases of type Ⅱ a,7 cases of type Ⅱ b,and 5 cases of type Ⅱ c.Among 16 patients,7 had simple anteromedial facet fractures of the ulnar coronoid process,and 9 had associated injury,including terrible triad in 3,Monteggia fractures in 4,and olecranon fractures in 2.All fractures were fixed with non-absorbable suture in 10 cases,and with suture anchor in 6 cases.The Mayo Elbow Performance Score (MEPS),range of motion (ROM),and complications were used to assess the elbow function. Results The incisions all healed by first intension,without neurovascular injury.Fifteen patients were followed up 10-48 months (mean,25.3 months).The X-ray films showed that all fractures healed,with the mean healing time of 17.5 weeks (range,11-30 weeks).At last follow-up,the mean MEPS score was 88.5(range,55-100);the results were excellent in 10 cases,good in 3 cases,fair in 1 case,and poor in 1 case,with an excellent and good rate of 86.7%.The mean ROM of flexion and extension was 118°(range,35-145°),and the mean ROM of forearm rotation was 138°(range,85-165°).One case had elbow instability,and 3 had slight pain.No heterotopic ossification and traumatic arthritis occurred during the follow-up. Conclusion The anteromedial facet fractures of the ulnar coronoid process can be clearly exposed through anterior approach,and the fracture fixation using non-absorbable suture and suture anchor fixation usually can restore the elbow function.

Citation： XUJian, SUNShengxuan, LICheng, ZHOUHaibin, DONGQirong. EFFECTIVENESS OF ANTERIOR APPROACH FOR TREATING ANTEROMEDIAL FACET FRACTURES OF ULNAR CORONOID PROCESS. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(7): 806-809. doi: 10.7507/1002-1892.20140179 Copy

1.	O'Driscoll SW,Bell DF,Morrey BF.Posterolateral rotatory instability of the elbow.J Bone Joint Surg (Am),1991,73(3):440-446.
2.	O'Driscoll SW,Jupiter JB,Cohen MS,et al.Difficult elbow fractures:pearls and pitfalls.Instr Course Lect,2003,52:113-134.
3.	Regan W,Morrey B.Fractures of the coronoid process of the ulna.J Bone Joint Surg (Am),1989,71(9):1348-1345.
4.	杜守超,张世民.尺骨冠突前内侧面骨折研究进展.国际骨科学杂志,2009,30(2):118-120.
5.	Longo UG,Franceschi F,Loppini M,et al.Rating systems for evaluation of elbow.British Medical Bulletin,2008,87(1):131-161.
6.	Weber MF,Barbosa DM,Belentani C,et al.Coronoid process of the ulna:paleopathologic and anatomic study with imaging correlation.Emphasis on the anteromedial "facet".Skeletal Radiol,2009,38(1):61-67.
7.	Cage DJ,Abrams RA,Callahan JJ,et al.Soft tissue attachments of the ulnar coronoid process.An anatomic study with radiographic correlation.Clin Orthop Relat Res,1995,(320):154-158.
8.	Callaway GH,Field LD,Deng XH,et al.Biomechanical evaluation of the medial collateral ligament of the elbow.J Bone Joint Surg (Am),1997,79(8):1223-1231.
9.	Doornberg JN,de Jong IM,Lindenhovius AL,et al.The anteromedial facet of the coronoid process of the ulna.J Shoulder Elbow Surg,2007,16(5):667-670.
10.	Doornberg JN,Ring DC.Fracture of the anteromedial facet of the coronoid process.J Bone Joint Surg (Am),2006,88(10):2216-2224.
11.	Ring DC,Jupiter JB.Surgical exposure of coronoid fractures.Tech Shoulder Elbow Surg,2002,3(1):48-56.
12.	Han SH,Yoon HK,Rhee SY,et al.Anterior approach for fixation of isolated type Ⅲ coronoid process fracture.Eur J Orthop Surg Traumatol,2013,23(4):395-405.
13.	Reichel LM,Milam GS,Reitman CA.Anterior approach for operative fixation of coronoid fractures in complex elbow instability.Tech Hand Up Extrem Surg,2012,16(2):98-104.
14.	张川,张作君,赵明,等.肘前内侧切口入路手术治疗尺骨冠状突前内侧面骨折.中国骨伤,2013,26(2):111-114.
15.	Clarke SE,Lee SY,Raphael JR.Coronoid fixation using suture anchors.Hand (N Y),2009,4(2):156-160.
16.	Garrigues GE,Wray WH 3rd,Lindenhovius AL,et al.Fixation of the coronoid process in elbow fracture-dislocations.J Bone Joint Surg (Am),2011,93(20):1873-1881.
17.	Moon JG,Zobitz ME,An KN,et al.Optimal screw orientation for fixation of the coronoid fractures.J Orthop Trauma,2009,23(4):277-280.
18.	黄洪斌,季向荣,范顺武,等.前内侧面尺骨冠状突的手术治疗策略.中国骨伤,2013,26(2):158-161.

1. O'Driscoll SW,Bell DF,Morrey BF.Posterolateral rotatory instability of the elbow.J Bone Joint Surg (Am),1991,73(3):440-446.
2. O'Driscoll SW,Jupiter JB,Cohen MS,et al.Difficult elbow fractures:pearls and pitfalls.Instr Course Lect,2003,52:113-134.
3. Regan W,Morrey B.Fractures of the coronoid process of the ulna.J Bone Joint Surg (Am),1989,71(9):1348-1345.
4. 杜守超,张世民.尺骨冠突前内侧面骨折研究进展.国际骨科学杂志,2009,30(2):118-120.
5. Longo UG,Franceschi F,Loppini M,et al.Rating systems for evaluation of elbow.British Medical Bulletin,2008,87(1):131-161.
6. Weber MF,Barbosa DM,Belentani C,et al.Coronoid process of the ulna:paleopathologic and anatomic study with imaging correlation.Emphasis on the anteromedial "facet".Skeletal Radiol,2009,38(1):61-67.
7. Cage DJ,Abrams RA,Callahan JJ,et al.Soft tissue attachments of the ulnar coronoid process.An anatomic study with radiographic correlation.Clin Orthop Relat Res,1995,(320):154-158.
8. Callaway GH,Field LD,Deng XH,et al.Biomechanical evaluation of the medial collateral ligament of the elbow.J Bone Joint Surg (Am),1997,79(8):1223-1231.
9. Doornberg JN,de Jong IM,Lindenhovius AL,et al.The anteromedial facet of the coronoid process of the ulna.J Shoulder Elbow Surg,2007,16(5):667-670.
10. Doornberg JN,Ring DC.Fracture of the anteromedial facet of the coronoid process.J Bone Joint Surg (Am),2006,88(10):2216-2224.
11. Ring DC,Jupiter JB.Surgical exposure of coronoid fractures.Tech Shoulder Elbow Surg,2002,3(1):48-56.
12. Han SH,Yoon HK,Rhee SY,et al.Anterior approach for fixation of isolated type Ⅲ coronoid process fracture.Eur J Orthop Surg Traumatol,2013,23(4):395-405.
13. Reichel LM,Milam GS,Reitman CA.Anterior approach for operative fixation of coronoid fractures in complex elbow instability.Tech Hand Up Extrem Surg,2012,16(2):98-104.
14. 张川,张作君,赵明,等.肘前内侧切口入路手术治疗尺骨冠状突前内侧面骨折.中国骨伤,2013,26(2):111-114.
15. Clarke SE,Lee SY,Raphael JR.Coronoid fixation using suture anchors.Hand (N Y),2009,4(2):156-160.
16. Garrigues GE,Wray WH 3rd,Lindenhovius AL,et al.Fixation of the coronoid process in elbow fracture-dislocations.J Bone Joint Surg (Am),2011,93(20):1873-1881.
17. Moon JG,Zobitz ME,An KN,et al.Optimal screw orientation for fixation of the coronoid fractures.J Orthop Trauma,2009,23(4):277-280.
18. 黄洪斌,季向荣,范顺武,等.前内侧面尺骨冠状突的手术治疗策略.中国骨伤,2013,26(2):158-161.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF ANTERIOR APPROACH FOR TREATING ANTEROMEDIAL FACET FRACTURES OF ULNAR CORONOID PROCESS

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