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Coronoid Fractures of the Elbow

Jason Wells, BS, University of Wisconsin School of Medicine and Public Health, Department of Orthopedics and Rehabilitation, K4/7 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-7375
Robert H. Ablove, MD, Assistant Professor, Chief Hand Surgery Service, University of Wisconsin School of Medicine and Public Health, Department of Orthopedics and Rehabilitation, K4/7 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-7375

Reprint Requests: Robert Ablove, MD, University of Wisconsin School of Medicine and Public Health, Department of Orthopedics and Rehabilitation, K4/7 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-7375, Tel: 608-263-9138, Fax: 608-265-6375, E-mail: Ablove{at}orthorehab.wisc.edu

Coronoid fractures of the ulna are relatively uncommon, yet critical injuries to recognize. They often occur in association with elbow dislocations and play an important role in elbow instability. Historic recommendations are to fix all large coronoid fracture fragments, as well as small fracture fragments associated with instability. There is little data regarding management of small coronoid fracture fragments. 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. Injured patients often present with swelling, tenderness and limited range of motion. After obtaining a detailed history and performing a careful physical examination, plain radiographs should be obtained. If present, dislocations are reduced and post-reduction stability is assessed. If the elbow is unstable, management usually consists of a combination of bony and soft-tissue repairs often including coronoid process repair. Loss of motion is the most common complication of these injuries. The current recommendation is to repair virtually all coronoid fractures associated with instability.

Key Words: Coronoid process fracture • Elbow instability • Elbow injury • Elbow trauma