The olecranon forms the posterior portion of this notch while the coronoid process forms the anterior portion. The proximal ulna forms a 190 degree arc about the trochlea known as the trochlear notch. Associated fractures, such as those involved in the so called “triad injuries” usually require operative management.Īnterior view of elbow joint articulations and points of rotation. Similar treatment can be successful with isolated undisplaced fractures. Simple dislocations without associated fractures usually respond to closed reduction, brief splinting, and gentle mobilization. Management of coronoid fractures associated with elbow dislocations is complex. 1, 2 They often occur in an injury, termed the “terrible triad of the elbow,” 3, 4, 5 which involves a posterior or posterolateral elbow dislocation, a radial head fracture, as well as a coronoid process fracture. The coronoid process of the ulna is one of the bony structures that can be fractured and has an important role in the stability of elbows after dislocation.Ĭoronoid fractures are relatively uncommon injuries occurring in approximately 2% to 15% of patients with dislocation. Traumatic elbow injuries, particularly those associated with a dislocation, can lead to elbow instability by damaging not only the bony structures, but also the soft tissues. The current recommendation is to repair virtually all coronoid fractures associated with instability. Loss of motion is the most common complication of these injuries. If the elbow is unstable, management usually consists of a combination of bony and soft-tissue repairs often including coronoid process repair. If present, dislocations are reduced and post-reduction stability is assessed. After obtaining a detailed history and performing a careful physical examination, plain radiographs should be obtained. Injured patients often present with swelling, tenderness and limited range of motion. The coronoid process acts as a bony buttress to prevent posterior dislocation and has three soft tissue insertions which lend stability as well: the anterior joint capsule of the elbow, the brachialis muscle and the medial ulnar collateral ligament. There is little data regarding management of small coronoid fracture fragments. Historic recommendations are to fix all large coronoid fracture fragments, as well as small fracture fragments associated with instability. They often occur in association with elbow dislocations and play an important role in elbow instability. Coronoid fractures of the ulna are relatively uncommon, yet critical injuries to recognize.
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