Surgical treatment of acute coronoid process fractures

Objectives: This study was designed to assess the results of surgical treatment for type 2-3 coronoid process fractures and to identify factors that might influence the outcome. Methods: Thirteen male patients (mean age 35 years; range 17 to 53 years) were treated with open reduction and inter¬nal fixation for displaced coronoid fractures. According to the Regan-Morrey classification, the fractures were type 2 in nine patients (69.2%), and type 3 in four patients (30.8%). Nine patients had associated injuries (elbow dislocation, ra¬dial head or olecranon fractures, and/or ligamentous injuries). The mean duration to treatment was 2.3 days (range 1 to 7 days). Functional results were assessed according to the Mayo elbow performance score (MEPS), and signs of arthritis were assessed according to the Broberg-Morrey criteria. The mean follow-up was 41.1 months (range 12 to 96 months). Results: A functional range of motion of the elbow joint was achieved in 10 patients (76.9%). The mean elbow range of motion was 110.7° (range 85° to 130°) and the mean forearm rotation was 134.2° (range 120° to 155°). Three patients who had comminuted fractures and associ¬ated elbow injuries had decreased range of motion. None of the patients exhibited signs of instability. The mean MEPS was 86.5 (range 75 to 100). The results were excel¬lent in four patients (30.8%; the mean MEPS 98.8) having isolated or noncomminuted coronoid fractures, and good in nine patients (69.2%) with comminuted fractures and/ or associated bone or ligament injuries. Post-traumatic ar¬thritis was detected in seven patients (53.9%) whose mean MEPS was 81.4. Patients with an excellent functional re¬sult did not develop arthritis. All the patients returned to preinjury activity levels. Conclusion: Coronoid fractures are the most important component of complex elbow injuries. The presence of com¬minuted fractures, associated bone and ligament injuries, and post-traumatic arthritis affect the outcome adversely.