Arthroscopic Fixation of Ulnar Coronoid Process Fracture With Suture and Button Stabilization

Ulnar coronoid fractures often cause elbow instability, whereas conservative treatment risks stiffness. Traditional open surgical approaches are frequently associated with challenges such as inadequate exposure, risks of neurovascular injury, and heterotopic ossification. Although arthroscopic transosseous fixation offers a less invasive alternative, it may still cause fragment comminution, particularly when the bone fragments are small. This technical note describes an arthroscopic fixation technique using the capsular-fragment continuity. The procedure involves placing high-strength sutures through the anterior capsule. A bony tunnel terminating at the fracture bed (without traversing the free fragment) is then created in the ulnar shaft using a posterior cruciate ligament reconstruction guide. A suture passer is advanced from the tunnel's posterior exit, through the capsular-fragment continuity, to retrieve the high-strength sutures, which are secured over an Endobutton plate for fixation. This technique provides a safe, effective, and minimally invasive option for coronoid fractures, especially with elbow instability.