Plate osteosynthesis of the coronoid process of the ulna

Objective: The aim of surgical treatment is reconstruction of the coronoid process' bony anatomy. Indications: Large shear fractures of the coronoid process (Regan-Morrey type II-III, O'Driscoll "tip" subtype 2 and "basal" subtype 1-2) and fractures of the anteromedial facet (O'Driscoll "anteromedial" subtype 1-3) can occur isolated or as part of the "terrible triad" injuries to the elbow. Due to the resulting instability of these injuries, surgical reconstruction is generally indicated. Contraindications: In case of major accompanying soft tissue injuries to the elbow or an elbow infection, primary operative treatment using anatomical plate osteosynthesis is contraindicated. Surgical technique: Plate osteosynthesis of the coronoid process is performed through a medial approach (Hotchkiss or M. flexor carpi ulnaris split). After repositioning of the fracture fragments, a preformed anatomical plate can be fixed to the coronoid process. Postoperative management: The arm is immobilized in an over-the-elbow cast until the wounds are dried. Afterwards, the elbow should preferably be treated functionally without varus or valgus stress. Results: Between January 2015 and July 2018, a total of 11 patients underwent osteosynthesis of the coronoid using anatomically preformed plate osteosynthesis. After a mean follow-up of 10.7 months, the mean Mayo Elbow Performance Score showed an excellent result with 78.89 points. The Quick Disabilities of Arm, Shoulder and Hand (Q-DASH) score showed a median of 18.64 points with a mean functional arc of 118 degrees.