Coronoid Fracture Flashcards
traumatic elbow fractures that are generally pathognomonic for an episode of elbow instability
coronoid fracture
coronoid fractures are traumatic elbow fractures that are generally pathognomonic for ____
an episode of elbow instability
coronoid fractures commonly occur with ____
elbow dislocation and recurrent instability after dislocation
mechanism
traumatic shear injury
typically occurs as distal humerus is driven against coronoid with an episode of severe _____ stress or posterior subluxation
varus
typically occurs as distal humerus is driven against coronoid with an episode of severe varus stress or ____ subluxation
posterior
fractures at the _____ can amplify elbow instability
coronoid base
anterior bundle of the medial ulnar collateral ligament attaches to the _____ 18 mm distal to tip
sublime tubercle
anterior bundle of the medial ulnar collateral ligament attaches to the sublime tubercle _____ mm distal to tip
18
anterior capsule attaches _____ mm distal to the tip of the coronoid
6
_____ attaches 6 mm distal to the tip of the coronoid
anterior capsule
associated conditions:
posteromedial rotatory instability
posterolateral rotatory instability
olecranon fracture-dislocation
terrible triad of elbow
coronoid anteromedial facet fracture and LCL disruption
posteromedial rotatory instablity
what is involved in posteromedial rotatory instability
coronoid anteromedial facet fracture and LCL disruption
posterolateral rotatory instability involves what
coronoid tip fracture, radial head fracture, and LCL injury
coronoid tip fracture, radial head fracture, and LCL injury
posterolateral rotatory instability
usually associated with a large coronoid fracture
olecranon fracture dislocation
what is the terrible triad of elbow
coronoid fracture (transverse fracture pattern), radial head fracture, and elbow dislocation
coronoid fracture (transverse fracture pattern), radial head fracture, and elbow dislocation
terrible triad of elbow
is the coronoid tip intra or extra articular
intra-articular
medial facet important for ____ stability
varus
_____ important for varus stability
medial facet
coronoid functions as an anterior buttress of the ____
olecranon greater sigmoid notch
oronoid functions as an _____ buttress of the olecranon greater sigmoid notch
anterior
important in preventing recurrent posterior subluxation
coronoid
coronoid is important in preventing recurrent _____
posterior subluxation
primary resistor of elbow subluxation or dislocation
coronoid
coronoid is primary resistor of ____
elbow subluxation or dislocation
presentation:
elbow deformity & swelling
elbow pain
forearm or wrist pain may be a sign of associated injuries
inspection and palpation will demonstrate:
varus or valgus deformity
ecchymosis & swelling
diffuse tenderness
recommended radiographs
AP and lateral of the elbow
useful for high grade injuries and comminuted fractures
CT
CT scan usage
useful for high grade injuries and comminuted fractures
nonoperative management includes:
brief period of immobilization, followed by early range of motion
non op indications
Type I, II, and III that are minimally displaced with stable elbow
Type I, II, and III that are minimally displaced with stable elbow op or non op
non op
operative techniques
ORIF with medial approach
ORIF with posterior approach
hinged external fixation
ORIF with medial approach indications
Type I, II, and III with persistent elbow instability
posteromedial rotatory instability
Type I, II, and III with persistent elbow instability
posteromedial rotatory instability
ORIF with medial approach
indications for ORIF with posterior approach
olecranon fracture dislocation
terrible triad of elbow
olecranon fracture dislocation
terrible triad of elbow
ORIF with posterior approach
indications for hinged external fixation
large fragments
poor bone quality
difficult revision cases to help maintain stability
large fragments
poor bone quality
difficult revision cases to help maintain stability
hinged external fixation
ORIF with medial approach interval
medial exposure through an interval between two heads of FCU
ORIF with medial approach-exposure more anteriorly through a split in ____ mass
flexor pronator
cerclage wire or No. 5 suture through ulna drill holes for Type ____ injuries
1
ORIF with retrograde cannulated screws or plate for Type _____
2 or 3
type 1 technique
cerclage wire or No. 5 suture through ulna drill holes
type 2 or 3 technique
ORIF with retrograde cannulated screws or plate
ORIF with buttress plate fixation or pins and lateral ligament repair for _____
posteromedial rotatory instability
posteromedial rotatory instability technique
ORIF with buttress plate fixation or pins and lateral ligament repair
post op rehab:
thermoplastic resting splint
avoid shoulder abduction for 4-6 weeks
early active motion
thermoplastic resting splint:
applied with elbow at 90° and forearm in neutral
restrict terminal 30° extension for 2-4 weeks
thermoplastic resting splint:
applied with elbow at 90° and forearm in neutral
restrict terminal _____ for 2-4 weeks
30 degrees extension
avoid shoulder abduction for 4-6 weeks to prevent ____ movement on arm
varus
dynamic muscle contraction may improve gapping of the ____ joint after surgical repair
ulnohumeral
ORIF with posterior approach technique
mobilize olecranon fracture to access coronoid fracture for associated olecranon fracture-dislocations
repair coronoid fragment first prior to reducing main ulnar fracture
olecranon ORIF with dorsal plate and screws
complications:
Recurrent elbow instability
Elbow stiffness
Posttraumatic arthritis
Heterotopic ossification
Early failure
