General guidelines to help deal with coronoid fractures.

4. - MCL complex: anterior
band, posterior, and
transverse.
- Anterior band is the most
important restraint against
Valgus stress.
- LCL complex: LRCL,
annular ligament, LUCL.
- LUCL is the main restraint
against posterolateral
instability and the first
injured in traumatic
posterolateral dislocation.
LIGAMENTOUSANATOMY

5. Distal humerus shows forward inclination of about
30 degrees.
Semilunar fossa is directed posterior ward.
This reciprocal orientation adds to stabilizing
effect of coronoid against posterior dislocation.
ARTICULAR
ORIENTATION

6. - Resistance of posteromedial
instability.
- The medial articular facet with LCL.
- It arises from fracture of the
anteromedial facet resulting in
varus instability.
- There is an associated injury of
either an avulsion of the lateral
collateral ligament complex from
the lateral epicondyle or a fracture
of the olecranon, or both.
- The radial head is rarely fractured
ROLEINSTABILITY

7. ASSOCIATEDFRACTURE

8. - Resistance to
posterolateral
instability.
- Result of axial load +
Valgus + and external
torque.
- In stages, Horii circle:
- 1- PLRI = injury of
LUCL
- 2- Where fracture tip
may occur.
- 3- Dislocation with
variable degree of
MCL injury and
avulsion of common
flexors in severe
form.
ROLEINSTABILITY

9. ASSOCIATEDFRACTURE

11. REGAN-MORREY
CLASSIFICATION

12. REVISIONOFREGAN-MORREYCLASSIFICATION

13. O’DRISCOLLCLASSIFICATION

14. O’DRISCOLL
CLASSIFICATION

17. -X-ray alone is not
sufficient.
-CT and reconstruction
films are needed.
IMAGING

22. -Medial approach:
-Use the interval
between two heads
of FCU, pronator
trees.
-Protect the ulnar
nerve, with possible
anterior
transposition.
-Separate lateral
incision for LUCL
repair.
SURGICALAPPROACH

23. Anteromedial facet fracture
repaired via medial
approach using buttress
plate.
Note the repaired LUCL.

24. - ORIF through posterior approach:
- Cases associated with olecranon fracture.
- Mobilize the olecranon fragment and repair coronoid first.
- Fixation of the olecranon.
SURGICALAPPROACH