A pre-contoured hook-plate simplifies anterior coronoid fixation: A matched-pair study

BackgroundThe modified anterior neurovascular interval approach provides direct access to the anterior coronoid while preserving the flexor-pronator origin. However, the narrow working corridor makes conventional mini-plate fixation technically challenging, often requiring repeated contouring and supplementary lag screws. We developed a specialized anatomical hook-plate (SAHP) and compared it with conventional mini-plate (CMP) fixation.MethodsWe retrospectively reviewed patients with unstable ulnar coronoid fractures (Regan-Morrey type II/III) treated via the anterior approach between January 2022 and January 2025. Twenty-five consecutive patients treated with SAHP were matched 1:1 with 25 CMP controls. Matching criteria included injury mechanism, Regan-Morrey classification, dominant fracture zone, and concomitant procedures. Operative time, supplementary lag screw use, union time, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, flexion-extension arc, and complications were compared.ResultsAll 50 patients completed follow-up (median, 12.5 months; range, 12-20 months). Operative time was significantly shorter in the SAHP group than in the CMP group (93.2 ± 26.8 vs. 112.4 ± 30.5 min; mean difference -19.2 min, 95% CI -29.8 to -8.6; P = 0.001). Supplementary lag screws were required in 15 patients (60.0%) in the CMP group and in none of the SAHP group (P < 0.001). All fractures achieved union. At final follow-up, functional outcomes (MEPS, DASH, flexion-extension arc) were similar between groups (all P > 0.05). No fixation failure or reoperation occurred.ConclusionsFor coronoid fractures requiring anterior buttress fixation, the SAHP simplifies the procedure by reducing operative time and eliminating the need for supplementary lag screws compared to conventional mini-plates. This may lower the technical barrier for this challenging approach while providing comparable short-term outcomes.