This review by Morrey synthesizes the biomechanical principles underlying complex elbow instability and translates them into a treatment framework. It addresses fracture-dislocations involving the radial head, olecranon, and coronoid — individually and in combination. The paper establishes a hierarchy of stabilizing structures and uses that hierarchy to rationalize when to fix, replace, or protect each element.
The core decision framework for complex elbow trauma is a hierarchy: restore the ulnohumeral joint first, address the radial head second, repair the lateral ligament in every case, and treat the medial ligament selectively.
The radial head's role as a secondary stabilizer is the highest-yield concept here. Resecting a fractured radial head is appropriate when the MCL is intact — but in any fracture-dislocation, the MCL is at risk and the radial head must be fixed or replaced, never simply excised.
Coronoid fractures are classified by the Regan-Morrey system, and the 50% threshold is the clinical decision point. Anything below 50% remaining means the joint cannot be reliably maintained without fixation or external support. The distraction external fixator neutralizes biceps and triceps forces that otherwise drive the humerus into the fracture site during every arc of motion.
Timing matters more than technique refinement: reconstruction of chronic instability or early arthritis is explicitly described as unpredictable at best. Acute anatomic restoration is the only reliable path to a good outcome.
This review by Morrey synthesizes the biomechanical principles underlying complex elbow instability and translates them into a treatment framework. It addresses fracture-dislocations involving the radial head, olecranon, and coronoid — individually and in combination. The paper establishes a hierarchy of stabilizing structures and uses that hierarchy to rationalize when to fix, replace, or protect each element.
The core decision framework for complex elbow trauma is a hierarchy: restore the ulnohumeral joint first, address the radial head second, repair the lateral ligament in every case, and treat the medial ligament selectively.
The radial head's role as a secondary stabilizer is the highest-yield concept here. Resecting a fractured radial head is appropriate when the MCL is intact — but in any fracture-dislocation, the MCL is at risk and the radial head must be fixed or replaced, never simply excised.
Coronoid fractures are classified by the Regan-Morrey system, and the 50% threshold is the clinical decision point. Anything below 50% remaining means the joint cannot be reliably maintained without fixation or external support. The distraction external fixator neutralizes biceps and triceps forces that otherwise drive the humerus into the fracture site during every arc of motion.
Timing matters more than technique refinement: reconstruction of chronic instability or early arthritis is explicitly described as unpredictable at best. Acute anatomic restoration is the only reliable path to a good outcome.