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

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Biomechanics

Background:

• The modified anterior neurovascular interval approach offers direct access to the anterior coronoid process.
• Conventional mini-plate fixation for these fractures is technically demanding due to a narrow working corridor, often necessitating supplementary fixation.
• A novel specialized anatomical hook-plate (SAHP) was developed to address these challenges.

Purpose of the Study:

• To compare the efficacy and outcomes of the specialized anatomical hook-plate (SAHP) versus conventional mini-plate (CMP) fixation for unstable ulnar coronoid fractures.
• To evaluate operative time, need for supplementary fixation, union rates, and functional outcomes.

Main Methods:

• Retrospective review of 50 patients with Regan-Morrey type II/III ulnar coronoid fractures treated via an anterior approach.
• Twenty-five patients treated with SAHP were matched 1:1 with 25 patients treated with CMP.
• Key outcomes measured included operative time, supplementary lag screw use, union time, Mayo Elbow Performance Score (MEPS), DASH score, range of motion, and complications.

Main Results:

• Operative time was significantly shorter in the SAHP group (mean difference -19.2 min, P = 0.001).
• Supplementary lag screws were required in 60% of the CMP group versus 0% in the SAHP group (P < 0.001).
• All fractures achieved union, with comparable functional outcomes (MEPS, DASH, flexion-extension arc) and no fixation failures or reoperations in either group.

Conclusions:

• The specialized anatomical hook-plate (SAHP) simplifies anterior buttress fixation for coronoid fractures.
• SAHP reduces operative time and eliminates the need for supplementary lag screws compared to conventional mini-plates.
• This technique may lower the technical barrier for anterior approaches to coronoid fractures, yielding comparable short-term functional results.