This Level III retrospective series by Doornberg and Ring examines 18 consecutive anteromedial facet coronoid fractures treated over six years at Massachusetts General Hospital. The central question: does secure internal fixation of this fracture improve outcomes compared to limited or no fixation? This paper established the injury as a discrete entity with a specific mechanism, associated ligament pattern, and operative treatment algorithm.
When you see a coronoid fracture on an elbow radiograph, the lateral view may look deceptively small. Get an AP view and CT — anteromedial facet fractures are defined by location, not size, and the Regan-Morrey size classification will lead you astray.
This paper establishes the operative decision rule: nearly every anteromedial facet coronoid fracture needs fixation. The only patients who can be observed are those with a very small fragment, no subluxation, and a negative varus stress radiograph. Everyone else needs medial exposure and buttress plating.
When the elbow has not dislocated, the MCL is usually intact. Your surgical plan focuses on the coronoid and LCL. When there is complete dislocation, assume both the LCL and MCL are injured and plan to repair both.
The authors found that varus instability is often subtle and only apparent on a stress radiograph under fluoroscopy. Do not skip this step intraoperatively or you will miss the diagnosis.
This Level III retrospective series by Doornberg and Ring examines 18 consecutive anteromedial facet coronoid fractures treated over six years at Massachusetts General Hospital. The central question: does secure internal fixation of this fracture improve outcomes compared to limited or no fixation? This paper established the injury as a discrete entity with a specific mechanism, associated ligament pattern, and operative treatment algorithm.
When you see a coronoid fracture on an elbow radiograph, the lateral view may look deceptively small. Get an AP view and CT — anteromedial facet fractures are defined by location, not size, and the Regan-Morrey size classification will lead you astray.
This paper establishes the operative decision rule: nearly every anteromedial facet coronoid fracture needs fixation. The only patients who can be observed are those with a very small fragment, no subluxation, and a negative varus stress radiograph. Everyone else needs medial exposure and buttress plating.
When the elbow has not dislocated, the MCL is usually intact. Your surgical plan focuses on the coronoid and LCL. When there is complete dislocation, assume both the LCL and MCL are injured and plan to repair both.
The authors found that varus instability is often subtle and only apparent on a stress radiograph under fluoroscopy. Do not skip this step intraoperatively or you will miss the diagnosis.