Transverse coronoid fracture: when does it have to be fixed?

Area of Science:

• Orthopedic surgery
• Biomechanics
• Trauma research

Background:

• Elbow fracture-dislocation treatment requires careful consideration for joint stability and early motion.
• The combined role of the radial head and coronoid in elbow stability remains incompletely understood.

Purpose of the Study:

• To assess the impact of a ~50% transverse coronoid fracture and its fixation on elbow laxity.
• To evaluate this in conjunction with an intact or resected radial head under varus and valgus stress.

Main Methods:

• Cadaveric elbow specimens were subjected to passive motion under varus and valgus gravity stress.
• Kinematic data were collected with reconstructed lateral collateral ligaments.
• Testing involved simulated coronoid fractures with and without radial head presence/fixation.

Main Results:

• Coronoid fixation significantly improved varus and internal rotational stability.
• Radial head status did not impact varus or rotational stability.
• The radial head was critical for valgus stability, especially when resected.

Conclusions:

• Fixing a 50% coronoid fracture enhances varus/internal rotational stability but offers limited benefit for valgus/external rotation.
• The radial head is a key stabilizer against valgus stress.
• Treatment decisions for coronoid fractures should consider varus load stability, and radial head integrity is paramount for overall elbow stability.