The document discusses coronoid fractures, emphasizing their complex anatomy and classifications, particularly the O'Driscoll classification for treatment decisions. It explores treatment options ranging from non-operative approaches to surgical interventions, depending on fracture patterns and associated injuries. The importance of imaging, like MRI and CT scans, in determining the stability of the elbow and guiding treatment strategies is highlighted.

1. CORONOID FRACTURE : Fix or not ?
Consultant Orthopedic
Upper Limb Surgery
Burjeel Hospital Dubai

2. SHAWN O’DRISCOLL,
Mayo Clinic, Rochester, 1999
1907
Professor Yves Allieu Montpellier, France
12 century
I have no conflicts of interest to disclose

3. Coronoid Anatomy
1. Tip
2. Rim
3. Base
4. Antero Medial Facet
5. Sublime tubercule / UCL insertion
6. Lesser sigmoid notch

4. The MEDIAL COLLATERAL LIGAMENT
Proximal
Distal
ELBOW IN EXTENSION

5. CORONOID DYNAMICS

6. Classifications
By location / Tip
By pathomechanisms

7. Odriscoll Classification Type I
Often isolated
PLRI
< 2 mm
> 2 mm
Transverse fracture of the TIP

8. Odriscoll Classification Type II
Rim
+ Sublime
Tubercle
< 2 mm
> 2 mm
< 50 % of coronoid body
Tip and Rim
ANTERO MEDIAL FACET
ST

9. Odriscoll Classification Type III
TransOlecranon
fracture
> 50 % of coronoid body
Terrible
Triad

10. Injury patterns
ELBOW DISLOCATION / SUBLUXATION
LIGAMENTS TEARS
2 POSSIBLE MECANISMS OF INJURY
Postero Lateral Rotatory Instability Postero Medial Rotatory Instability
PLRI PMRI
Type I. LCL. RH. MCL LCL. Type II AMF. pMCL

11. QUESTIONS
Isolated fracture VS Associated radial head fracture ?
Fracture fragments size and number of fragments ?
Did the elbow dislocate ?
Degree of dislocation ?

12. TREATMENT OPTIONS
NON OPERATIVE
SURGERY MOST OF THE CASES

14. Medial approaches

15. Case discussion
M, 36 yo
Fell from truck
Fracture dislocation R elbow
Neuro vascular ok

16. What do you do ?
This patient
First reduction on sedation –

17. MRI
Still dislocated
CORONOIDE IS THE KEY !
Controlled by MRI

18. What do you do ?

19. PLRI
Controlled by CT Scan
They tried second reduction under GA
And planned for EX FIX !!!

20. What do you do ?
Anteromedial type II, 3
You receive this patient 3 days after trauma

21. EUA
ANTERO MEDIAL
FACET

22. LCL Complex repair
Coronoid ORIF

23. CLOSURE
ULNAR NERVE
CUTANEOUS
BRANCHES
MEDIAL
EPICONDYLE

24. DAY 1

26. Stabilty
Result
@3 months

27. RESULTS 6 MONTHS

28. Second case
• 46 yo, F
• Fell from height
• 7 days ago
• Abroad
• Non reduced
in the cast !

29. What to do ?

30. Reduction

31. MRI

33. Technique de laçage
du processus coronoïde
Morrey- Master techniques, 2002
OSTEO SUTURE

34. Technique de laçage
du processus coronoïde
Morrey- Master techniques, 2002
OSTEO SUTURE

35. LATERAL APPROACH :
- Lcl repair
- Radial head prosthesis
- Coronoid osteosuture

36. In Summary
Coronoid Fxs – rarely isolated injuries
Sig biomechanical effects on elbow stability : > 30-50%
CT Scan mandatory
O’driscoll Classification
Operative treatment : predictable, based on injury pattern
Primary goal of Sx : restore stability
Treatment strategy :
- Associated injury patterns
- Multiple fixation options

37. THANK YOU