This review covers the anatomy, classification, biomechanics, and surgical management of coronoid process fractures of the elbow. It frames the coronoid as a key bony stabilizer and explains how the injury pattern dictates surgical approach. It distinguishes terrible triad tip fractures from anteromedial facet fractures.
The decision rule starts with the injury pattern, not the fracture size alone. A terrible triad (dislocation, radial head fracture, small tip fracture) is a valgus posterolateral injury. Approach laterally, fix or replace the radial head, repair the LCL, and if the coronoid is 15% or less it can be ignored.
An anteromedial facet fracture is a varus posteromedial injury. This one is dangerous because it looks small on plain films but produces varus subluxation and early arthrosis if missed. Get a CT, buttress-plate the coronoid medially, and repair the LCL.
Remember the biomechanics: small coronoid defects add little bony stability, so a well-fixed radial head and repaired ligaments carry the load. But a 50% defect cannot be compensated by the radial head, so it must be fixed. The evidence base here is level III to IV, so treatment algorithms remain based on biomechanics and expert experience rather than randomized data.
This review covers the anatomy, classification, biomechanics, and surgical management of coronoid process fractures of the elbow. It frames the coronoid as a key bony stabilizer and explains how the injury pattern dictates surgical approach. It distinguishes terrible triad tip fractures from anteromedial facet fractures.
The decision rule starts with the injury pattern, not the fracture size alone. A terrible triad (dislocation, radial head fracture, small tip fracture) is a valgus posterolateral injury. Approach laterally, fix or replace the radial head, repair the LCL, and if the coronoid is 15% or less it can be ignored.
An anteromedial facet fracture is a varus posteromedial injury. This one is dangerous because it looks small on plain films but produces varus subluxation and early arthrosis if missed. Get a CT, buttress-plate the coronoid medially, and repair the LCL.
Remember the biomechanics: small coronoid defects add little bony stability, so a well-fixed radial head and repaired ligaments carry the load. But a 50% defect cannot be compensated by the radial head, so it must be fixed. The evidence base here is level III to IV, so treatment algorithms remain based on biomechanics and expert experience rather than randomized data.