This is a retrospective series of 18 patients with fractures of the anteromedial facet of the coronoid process, a fracture from a varus posteromedial rotational force. It asks whether these fractures benefit from secure internal fixation versus limited or no treatment.
When you see a small coronoid fragment on a lateral elbow film, get an AP view and a varus stress radiograph. A fracture that involves the anteromedial facet is not benign.
The mechanism is varus posteromedial rotation, different from the posterolateral rotatory force behind most elbow fracture-dislocations. Because the facet is the medial bony buttress, losing it lets the trochlea subluxate into the defect and the joint arthroses.
This series shows the consequence directly: secure medial buttress fixation gave uniformly good results, while limited or absent treatment produced instability in 7 of 9 patients and arthrosis in 6.
Practical anatomy points: if the elbow is not dislocated the MCL is usually intact, but the LCL is nearly always avulsed and must be reattached. Avoid routine ulnar nerve transposition, since both nerve palsies here came from handling the mobilized nerve. The data are Level III from a single surgeon, so the fixation recommendation is grounded but not definitive.
This is a retrospective series of 18 patients with fractures of the anteromedial facet of the coronoid process, a fracture from a varus posteromedial rotational force. It asks whether these fractures benefit from secure internal fixation versus limited or no treatment.
When you see a small coronoid fragment on a lateral elbow film, get an AP view and a varus stress radiograph. A fracture that involves the anteromedial facet is not benign.
The mechanism is varus posteromedial rotation, different from the posterolateral rotatory force behind most elbow fracture-dislocations. Because the facet is the medial bony buttress, losing it lets the trochlea subluxate into the defect and the joint arthroses.
This series shows the consequence directly: secure medial buttress fixation gave uniformly good results, while limited or absent treatment produced instability in 7 of 9 patients and arthrosis in 6.
Practical anatomy points: if the elbow is not dislocated the MCL is usually intact, but the LCL is nearly always avulsed and must be reattached. Avoid routine ulnar nerve transposition, since both nerve palsies here came from handling the mobilized nerve. The data are Level III from a single surgeon, so the fixation recommendation is grounded but not definitive.