BACKGROUND: Fracture of the anteromedial facet of the coronoid was
recently recognized as a distinct type of coronoid fracture resulting from a
varus posteromedial rotational injury force. Very few reports are available to
help guide the management of these injuries.
METHODS: Eighteen patients with a fracture of the anteromedial facet
of the coronoid process were treated over a six-year period. Twelve patients
were treated for the acute fracture, and six were managed after initial
treatment elsewhere. All but three patients (two with concomitant fracture of
the olecranon and one with a second fracture at the base of the coronoid) had
avulsion of the origin of the lateral collateral ligament complex from the
lateral epicondyle. The initial treatment was operative in fifteen patients
and nonoperative in three. The coronoid fracture was secured with a plate
applied to the medial surface of the coronoid in nine patients, a screw in one
patient, and sutures in one patient. It was not repaired in the remaining
RESULTS: At the final evaluation, an average of twenty-six months
after the injury, six patients had malalignment of the anteromedial facet of
the coronoid with varus subluxation of the elbow, which was due to the fact
that the fracture had not been specifically treated in four patients and to
loss of fracture fixation in two patients. All six had development of
arthrosis and a fair or poor result according to the system of Broberg and
Morrey. The remaining twelve patients had good or excellent elbow
CONCLUSIONS: Anteromedial fractures of the coronoid are associated
with either subluxation or complete dislocation of the elbow in most patients.
Secure fixation of the coronoid fracture usually restores good elbow
LEVEL OF EVIDENCE: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.
ORIGINAL ABSTRACT CITATION: "Fracture of the Anteromedial Facet of
the Coronoid Process"