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Strategic approach to O'Driscoll type 2 anteromedial coronoid facet fracture.
J Shoulder Elbow Surg. 2014 Jul; 23(7):924-32.JS

Abstract

BACKGROUND

The purpose of this study was to suggest a strategic approach to the management of anteromedial coronoid facet (AMCF) fracture that is related to posteromedial rotational instability of the elbow through investigation of the surgical outcome of diverse combinations, including internal fixation of AMCF fractures and repair of collateral ligament injury.

METHODS

The study enrolled 18 patients. On the basis of the size of the coronoid fracture and the degree of the soft tissue injuries that were evaluated with computed tomography, magnetic resonance imaging, and varus stress test under anesthesia, these fractures were managed differently. Functional outcomes were evaluated with the visual analog scale score, modified Mayo Elbow Performance Score, and Disabilities of the Arm, Shoulder and Hand score. Plain radiographs were used to evaluate the degree of arthrosis.

RESULTS

There were 2 cases of O'Driscoll type 2, subtype 1 fractures; 14 cases of type 2, subtype 2 fractures; and 2 cases of type 2, subtype 3 fractures. Seven cases were managed with only AMCF fracture fixation, 4 cases with only lateral ulnar collateral ligament (LUCL) repair, 6 cases with concomitant repair of the LUCL and AMCF fracture, and 1 case with a conservative method. There were no significant differences among O'Driscoll types and among the subgroups of type 2-2 (P > .05). When the elbow showed instability on the varus stress test after AMCF fracture fixation, the soft tissue injuries of the lateral elbow were more severe (P =. 015). Arthrosis was not correlated with the patient's symptoms (P > .05).

CONCLUSION

AMCF fracture can be treated by only AMCF fracture fixation, only LUCL repair, or a combination of these techniques, depending on the size of the AMCF fracture fragment and the degree of the lateral soft tissue injuries.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeng Christianity Hospital, Pohang, Kyeongbuk, South Korea. Electronic address: osdrrih@gmail.com.Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeng Christianity Hospital, Pohang, Kyeongbuk, South Korea.Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeng Christianity Hospital, Pohang, Kyeongbuk, South Korea.Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeng Christianity Hospital, Pohang, Kyeongbuk, South Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24810081

Citation

Rhyou, In Hyeok, et al. "Strategic Approach to O'Driscoll Type 2 Anteromedial Coronoid Facet Fracture." Journal of Shoulder and Elbow Surgery, vol. 23, no. 7, 2014, pp. 924-32.
Rhyou IH, Kim KC, Lee JH, et al. Strategic approach to O'Driscoll type 2 anteromedial coronoid facet fracture. J Shoulder Elbow Surg. 2014;23(7):924-32.
Rhyou, I. H., Kim, K. C., Lee, J. H., & Kim, S. Y. (2014). Strategic approach to O'Driscoll type 2 anteromedial coronoid facet fracture. Journal of Shoulder and Elbow Surgery, 23(7), 924-32. https://doi.org/10.1016/j.jse.2014.02.016
Rhyou IH, et al. Strategic Approach to O'Driscoll Type 2 Anteromedial Coronoid Facet Fracture. J Shoulder Elbow Surg. 2014;23(7):924-32. PubMed PMID: 24810081.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Strategic approach to O'Driscoll type 2 anteromedial coronoid facet fracture. AU - Rhyou,In Hyeok, AU - Kim,Kyung Chul, AU - Lee,Ji-Ho, AU - Kim,Seung Yeon, Y1 - 2014/05/06/ PY - 2013/10/30/received PY - 2014/02/14/revised PY - 2014/02/27/accepted PY - 2014/5/10/entrez PY - 2014/5/9/pubmed PY - 2014/9/16/medline KW - Anteromedial coronoid facet fracture KW - lateral ulnar collateral ligament KW - posteromedial rotatory instability SP - 924 EP - 32 JF - Journal of shoulder and elbow surgery JO - J Shoulder Elbow Surg VL - 23 IS - 7 N2 - BACKGROUND: The purpose of this study was to suggest a strategic approach to the management of anteromedial coronoid facet (AMCF) fracture that is related to posteromedial rotational instability of the elbow through investigation of the surgical outcome of diverse combinations, including internal fixation of AMCF fractures and repair of collateral ligament injury. METHODS: The study enrolled 18 patients. On the basis of the size of the coronoid fracture and the degree of the soft tissue injuries that were evaluated with computed tomography, magnetic resonance imaging, and varus stress test under anesthesia, these fractures were managed differently. Functional outcomes were evaluated with the visual analog scale score, modified Mayo Elbow Performance Score, and Disabilities of the Arm, Shoulder and Hand score. Plain radiographs were used to evaluate the degree of arthrosis. RESULTS: There were 2 cases of O'Driscoll type 2, subtype 1 fractures; 14 cases of type 2, subtype 2 fractures; and 2 cases of type 2, subtype 3 fractures. Seven cases were managed with only AMCF fracture fixation, 4 cases with only lateral ulnar collateral ligament (LUCL) repair, 6 cases with concomitant repair of the LUCL and AMCF fracture, and 1 case with a conservative method. There were no significant differences among O'Driscoll types and among the subgroups of type 2-2 (P > .05). When the elbow showed instability on the varus stress test after AMCF fracture fixation, the soft tissue injuries of the lateral elbow were more severe (P =. 015). Arthrosis was not correlated with the patient's symptoms (P > .05). CONCLUSION: AMCF fracture can be treated by only AMCF fracture fixation, only LUCL repair, or a combination of these techniques, depending on the size of the AMCF fracture fragment and the degree of the lateral soft tissue injuries. SN - 1532-6500 UR - https://www.unboundmedicine.com/medline/citation/24810081/Strategic_approach_to_O'Driscoll_type_2_anteromedial_coronoid_facet_fracture_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1058-2746(14)00155-4 DB - PRIME DP - Unbound Medicine ER -