Surgical Management of Pediatric Coronoid Process Fractures: A Report of Two Cases

Coronoid process fractures in the pediatric population are rare and often misdiagnosed, leading to chronic elbow instability. We aim to evaluate the surgical management of two adolescent cases of inveterate coronoid fractures using autologous bone grafting. Both patients, with a history of recurrent elbow dislocations, presented with pseudoarthrosis and were initially misdiagnosed due to minor or subtle fractures. Comprehensive imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), confirmed the presence of significant coronoid defects. The surgical intervention involved employing autografts from the iliac wing to reconstruct the coronoid process, followed by fixation with screws. Both patients underwent postoperative rehabilitation via physiotherapy, resulting in full functional recovery. At their one-year follow-ups, both patients regained full elbow function, achieving range-of-motion measurements of 0-0-130° flexion-extension and 90-0-90° pronation-supination; no recurrence of instability was reported, with no complications at the yearly follow-ups. This approach demonstrates the efficacy of autograft reconstruction in restoring elbow stability, particularly in cases with substantial bone loss or pseudoarthrosis. Our study highlights the importance of advanced imaging and individualized treatment strategies, emphasizing that early surgical intervention can prevent long-term disability in pediatric patients with chronic coronoid fractures.