Usability of Minimal Invasive Surgery for Elbow Dislocation with Coronoid Process Fracture: A Protocol Development...

Area of Science:

• Orthopedic Surgery
• Traumatology
• Minimally Invasive Techniques

Background:

• Elbow fracture-dislocation with coronoid process fracture presents complex surgical challenges.
• Traditional open approaches may lead to increased morbidity.
• Assessing the feasibility of minimally invasive surgery (MIS) is crucial for optimizing patient outcomes.

Purpose of the Study:

• To determine the feasibility of minimal invasive surgery (MIS) for elbow fracture-dislocation specifically involving coronoid process fractures.
• To evaluate the efficacy of a fluoroscopy-guided ulnar anteromedial (FGUAM) approach in managing these injuries.

Main Methods:

• A cohort of patients with elbow dislocations and coronoid process fractures were treated using MIS techniques by a single surgeon.
• The fluoroscopy-guided ulnar anteromedial (FGUAM) approach was employed for coronoid process reduction.
• Adjunctive posterior, lateral, or medial incisions were utilized as necessary for associated proximal ulnar fractures, radial head fractures, or ligament injuries.

Main Results:

• A flow diagram was developed to guide approach selection based on MIS principles, defined as procedures avoiding cross-plane dissection.
• The study emphasized the critical role of anterior rigid fixation for the coronoid process.
• The FGUAM approach was shown to reduce cross-plane dissection.

Conclusions:

• Minimal invasive surgery (MIS) is achievable for elbow fracture-dislocation with coronoid process fracture through multiple limited incisions.
• While a posterior extensile approach remains necessary for specific complex fractures (e.g., ulnar metaphysis, ligament avulsion), the FGUAM approach offers a less invasive alternative for coronoid process management.
• These findings support the integration of MIS techniques to improve surgical management of complex elbow injuries.