Hyun-Dae Shin; Soo-Min Cha

doi:10.12671/jkfs.2012.25.4.342

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Current Concepts in the Treatment of Complex Elbow Fracture-Dislocation: Hyun-Dae Shin, M.D., Ph.D., Soo-Min Cha, M.D.; Journal of the Korean Fracture Society 2012;25(4):342-351.
DOI: https://doi.org/10.12671/jkfs.2012.25.4.342
Published online: October 19, 2012

Department of Orthopaedic Surgery, Research Institute for Medical Sciences, Chungnam National University Hospital, Daejeon, Korea.

Address reprint requests to: Hyun-Dae Shin, M.D., Ph.D. Department of Orthopaedic Surgery, Research Institute for Medical Sciences, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel: 82-42-280-7349, Fax: 82-42-252-7098, hyunsd@cnu.ac.kr

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REFERENCES

1. Adams JE, Hoskin TL, Morrey BF, Steinmann SP. Management and outcome of 103 acute fractures of the coronoid process of the ulna. J Bone Joint Surg Br, 2009;91:632-635.
2. Bado JL. The Monteggia lesion. Clin Orthop Relat Res, 1967;50:71-86.
3. Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ. The effect of radial head fracture size on elbow kinematics and stability. J Orthop Res, 2005;23:210-217.
4. Beingessner DM, Stacpoole RA, Dunning CE, Johnson JA, King GJ. The effect of suture fixation of type I coronoid fractures on the kinematics and stability of the elbow with and without medial collateral ligament repair. J Shoulder Elbow Surg, 2007;16:213-217.
5. Boyd HB, Boals JC. The Monteggia lesion. A review of 159 cases. Clin Orthop Relat Res, 1969;66:94-100.
6. Broberg MA, Morrey BF. Results of treatment of fracture-dislocations of the elbow. Clin Orthop Relat Res, 1987;(216):109-119.
7. Bruce HE, Harvey JP, Wilson JC Jr. Monteggia fractures. J Bone Joint Surg Am, 1974;56:1563-1576.
8. Cohen MS. Fractures of the coronoid process. Hand Clin, 2004;20:443-453.
9. Doornberg JN, de Jong IM, Lindenhovius AL, Ring D. The anteromedial facet of the coronoid process of the ulna. J Shoulder Elbow Surg, 2007;16:667-670.
10. Doornberg JN, Linzel DS, Zurakowski D, Ring D. Reference points for radial head prosthesis size. J Hand Surg Am, 2006;31:53-57.
11. Doornberg JN, Parisien R, van Duijn PJ, Ring D. Radial head arthroplasty with a modular metal spacer to treat acute traumatic elbow instability. J Bone Joint Surg Am, 2007;89:1075-1080.
12. Doornberg JN, Ring D. Coronoid fracture patterns. J Hand Surg Am, 2006;31:45-52.
13. Doornberg JN, Ring DC. Fracture of the anteromedial facet of the coronoid process. J Bone Joint Surg Am, 2006;88:2216-2224.
14. Forthman C, Henket M, Ring DC. Elbow dislocation with intra-articular fracture: the results of operative treatment without repair of the medial collateral ligament. J Hand Surg Am, 2007;32:1200-1209.
15. Frank SG, Grewal R, Johnson J, Faber KJ, King GJ, Athwal GS. Determination of correct implant size in radial head arthroplasty to avoid overlengthening. J Bone Joint Surg Am, 2009;91:1738-1746.
16. Furry KL, Clinkscales CM. Comminuted fractures of the radial head. Arthroplasty versus internal fixation. Clin Orthop Relat Res, 1998;(353):40-52.
17. Garrigues GE, Wray WH 3rd, Lindenhovius AL, Ring DC, Ruch DS. Fixation of the coronoid process in elbow fracture-dislocations. J Bone Joint Surg Am, 2011;93:1873-1881.
18. Geel CW, Palmer AK, Ruedi T, Leutenegger AF. Internal fixation of proximal radial head fractures. J Orthop Trauma, 1990;4:270-274.
19. Grewal R, MacDermid JC, Faber KJ, Drosdowech DS, King GJ. Comminuted radial head fractures treated with a modular metallic radial head arthroplasty. Study of outcomes. J Bone Joint Surg Am, 2006;88:2192-2200.
20. Harrington IJ, Sekyi-Otu A, Barrington TW, Evans DC, Tuli V. The functional outcome with metallic radial head implants in the treatment of unstable elbow fractures: a long-term review. J Trauma, 2001;50:46-52.
21. Hotchkiss RN. Displaced fractures of the radial head: internal fixation or excision? J Am Acad Orthop Surg, 1997;5:1-10.
22. Hull JR, Owen JR, Fern SE, Wayne JS, Boardman ND 3rd. Role of the coronoid process in varus osteoarticular stability of the elbow. J Shoulder Elbow Surg, 2005;14:441-446.
23. Jupiter JB, Leibovic SJ, Ribbans W, Wilk RM. The posterior Monteggia lesion. J Orthop Trauma, 1991;5:395-402.
24. King GJ, Evans DC, Kellam JF. Open reduction and internal fixation of radial head fractures. J Orthop Trauma, 1991;5:21-28.
25. Konrad GG, Kundel K, Kreuz PC, Oberst M, Sudkamp NP. Monteggia fractures in adults: long-term results and prognostic factors. J Bone Joint Surg Br, 2007;89:354-360.
26. Lindenhovius AL, Felsch Q, Doornberg JN, Ring D, Kloen P. Open reduction and internal fixation compared with excision for unstable displaced fractures of the radial head. J Hand Surg Am, 2007;32:630-636.
27. Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg, 1954;42:123-132.
28. Mathew PK, Athwal GS, King GJ. Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg, 2009;17:137-151.
29. McKee MD, Pugh DM, Wild LM, Schemitsch EH, King GJ. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Surgical technique. J Bone Joint Surg Am, 2005;87:Suppl 1. 22-32.
30. Monteggia GB. Istituzioni chirurgiche, 1814;Milan, Giuseppe Maspero.
31. Moro JK, Werier J, MacDermid JC, Patterson SD, King GJ. Arthroplasty with a metal radial head for unreconstructible fractures of the radial head. J Bone Joint Surg Am, 2001;83-A:1201-1211.
32. O'Driscoll SW, Jupiter JB, Cohen MS, Ring D, McKee MD. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect, 2003;52:113-134.
33. Pike JM, Athwal GS, Faber KJ, King GJ. Radial head fractures-an update. J Hand Surg Am, 2009;34:557-565.
34. Pugh DM, McKee MD. The "terrible triad" of the elbow. Tech Hand Up Extrem Surg, 2002;6:21-29.
35. Pugh DM, Wild LM, Schemitsch EH, King GJ, McKee MD. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg Am, 2004;86-A:1122-1130.
36. Reckling FW. Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions). J Bone Joint Surg Am, 1982;64:857-863.
37. Reckling FW, Cordell LD. Unstable fracture-dislocations of the forearm. The Monteggia and Galeazzi lesions. Arch Surg, 1968;96:999-1007.
38. Regan W, Morrey B. Fractures of the coronoid process of the ulna. J Bone Joint Surg Am, 1989;71:1348-1354.
39. Reynders P, De Groote W, Rondia J, Govaerts K, Stoffelen D, Broos PL. Monteggia lesions in adults. A multicenter Bota study. Acta Orthop Belg, 1996;62:Suppl 1. 78-83.
40. Ring D, Quintero J, Jupiter JB. Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am, 2002;84-A:1811-1815.
41. Rosenblatt Y, Athwal GS, Faber KJ. Current recommendations for the treatment of radial head fractures. Orthop Clin North Am, 2008;39:173-185.
42. Rowland AS, Athwal GS, MacDermid JC, King GJ. Lateral ulnohumeral joint space widening is not diagnostic of radial head arthroplasty overstuffing. J Hand Surg Am, 2007;32:637-641.
43. Van Glabbeek F, Van Riet RP, Baumfeld JA, et al. Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateral-ligament deficient elbow. J Bone Joint Surg Am, 2004;86-A:2629-2635.
44. van Riet RP, van Glabbeek F, de Weerdt W, Oemar J, Bortier H. Validation of the lesser sigmoid notch of the ulna as a reference point for accurate placement of a prosthesis for the head of the radius: a cadaver study. J Bone Joint Surg Br, 2007;89:413-416.
45. Van Riet RP, Van Glabbeek F, Verborgt O, Gielen J. Capitellar erosion caused by a metal radial head prosthesis. A case report. J Bone Joint Surg Am, 2004;86-A:1061-1064.
46. Sanchez-Sotelo J, O'Driscoll SW, Morrey BF. Anteromedial fracture of the coronoid process of the ulna. J Shoulder Elbow Surg, 2006;15:e5-e8.
47. Sanchez-Sotelo J, O'Driscoll SW, Morrey BF. Medial oblique compression fracture of the coronoid process of the ulna. J Shoulder Elbow Surg, 2005;14:60-64.
48. Schneeberger AG, Sadowski MM, Jacob HA. Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow. J Bone Joint Surg Am, 2004;86-A:975-982.
49. Shors HC, Gannon C, Miller MC, Schmidt CC, Baratz ME. Plain radiographs are inadequate to identify overlengthening with a radial head prosthesis. J Hand Surg Am, 2008;33:335-339.

Fig. 1

Algorithm for the surgical management of the terrible triad injury to the elbow. ^*Radial neck osteotomy in preparation for radial head replacement. ^†Type I coronoid fractures may not require repair. Revised from the article of Mathew PK, et al. (Fig. 5) with permission28).

Fig. 2

(A) Preoperative antero-posterior and lateral radiographs.

(B) Regan and Morrey type I coronoid fracture, type I radial head fracture was observed in computed tomography.

(C) Only lateral ulnar collateral ligament has been sutured with Mitek anchor and stability was achieved.

Fig. 3

Postoperative anteroposterior and lateral radiographs show reduced joint with fixation of the coronoid process.

Fig. 4

Illustration depicting the lasso coronoid fracture fixation technique through ulnar drill holes (Revised from Garrigues GE, et al. (Fig. 3) with permission17).

Fig. 5

(A) Subluxated radiocapitellar joint was observed despite manual reduction of terrible triad injury.

(B) Anteroposterior and lateral radiographs of an elbow fracture-dislocation that inadequately characterized the extent of bony injury. Three-dimensional computed tomography scan showing anteromedial facet fragment and olecrenon fragment.

(C) Locking plate and screws were used for fixation of coronoid fracture and olecrenon fragment.

Fig. 6

Anteroposterior and lateral radiographs of an elbow fracture-dislocation that inadequately characterized the extent of bony injury. Three-dimensional computed tomography scans show the radial head fracture and associated comminuted proximal ulnar and coronoid fracture.

Table 1

Rehabilitation Protocol after Surgical Treatment of Elbow Dislocations with Radial Head Fracture with or without Coronoid Fracture

LCL: Lateral collateral ligament, MCL: Medial collateral ligament.

Table 2

O'Driscoll Classification of Coronoid Process Fractures

Figure & Data

REFERENCES

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Modified Suture Lasso Technique for the Coronoid Process Fractures of the Elbow: Technical Note
Changhyun Park, Woojin Shin, Seung-Pyo Suh
Journal of the Korean Orthopaedic Association.2024; 59(1): 72. CrossRef

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Current Concepts in the Treatment of Complex Elbow Fracture-Dislocation

J Korean Fract Soc. 2012;25(4):342-351. Published online October 31, 2012

DOI: https://doi.org/10.12671/jkfs.2012.25.4.342

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Current Concepts in the Treatment of Complex Elbow Fracture-Dislocation

Fig. 1 Algorithm for the surgical management of the terrible triad injury to the elbow. *Radial neck osteotomy in preparation for radial head replacement. †Type I coronoid fractures may not require repair. Revised from the article of Mathew PK, et al. (Fig. 5) with permission28).

Fig. 2 (A) Preoperative antero-posterior and lateral radiographs. (B) Regan and Morrey type I coronoid fracture, type I radial head fracture was observed in computed tomography. (C) Only lateral ulnar collateral ligament has been sutured with Mitek anchor and stability was achieved.

Fig. 3 Postoperative anteroposterior and lateral radiographs show reduced joint with fixation of the coronoid process.

Fig. 4 Illustration depicting the lasso coronoid fracture fixation technique through ulnar drill holes (Revised from Garrigues GE, et al. (Fig. 3) with permission17).

Fig. 5 (A) Subluxated radiocapitellar joint was observed despite manual reduction of terrible triad injury. (B) Anteroposterior and lateral radiographs of an elbow fracture-dislocation that inadequately characterized the extent of bony injury. Three-dimensional computed tomography scan showing anteromedial facet fragment and olecrenon fragment. (C) Locking plate and screws were used for fixation of coronoid fracture and olecrenon fragment.

Fig. 6 Anteroposterior and lateral radiographs of an elbow fracture-dislocation that inadequately characterized the extent of bony injury. Three-dimensional computed tomography scans show the radial head fracture and associated comminuted proximal ulnar and coronoid fracture.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Current Concepts in the Treatment of Complex Elbow Fracture-Dislocation

Table 1

Rehabilitation Protocol after Surgical Treatment of Elbow Dislocations with Radial Head Fracture with or without Coronoid Fracture

LCL: Lateral collateral ligament, MCL: Medial collateral ligament.

Table 2

O'Driscoll Classification of Coronoid Process Fractures

Table 1 Rehabilitation Protocol after Surgical Treatment of Elbow Dislocations with Radial Head Fracture with or without Coronoid Fracture

LCL: Lateral collateral ligament, MCL: Medial collateral ligament.

Table 2 O'Driscoll Classification of Coronoid Process Fractures