Selected anteromedial coronoid fractures can be treated nonoperatively.
BACKGROUND
Surgical fixation is currently recommended for unstable anteromedial coronoid fractures, but the role of nonoperative management is not well defined. Our purpose was to report the functional and radiographic outcomes of select patients managed nonoperatively.


METHODS
Between 2006 and 2012, 10 patients with anteromedial coronoid fractures underwent nonoperative treatment. Outcomes assessed included elbow range of motion (ROM), stability, strength, radiographs, and 3 functional questionnaires, including the Patient-Rated Elbow Evaluation, Disabilities of Arm, Shoulder and Hand, and Mayo Elbow Performance Index.


RESULTS
There were 9 anteromedial subtype 2 coronoid fractures and 1 subtype 3. Mean fragment size was 5 mm, with a mean displacement of 3 mm for the subtype 2 fractures. The subtype 3 fracture was 9 mm in size with 1 mm of maximal gap displacement. At a mean follow-up of 50 months (range, 12-83 months), the average ROM of the affected elbow was 137° ± 8° of flexion, 2° ± 5° of extension, 88° ± 5° of pronation, and 86° ± 10° of supination. The mean Patient-Rated Elbow Evaluation score was 9 ± 13, Mayo Elbow Performance Index score was 94 ± 8, and the Disabilities of Arm, Shoulder and Hand score was 7 ± 9. All patients had bony union without radiographic arthrosis. There were no cases of recurrent instability or delayed surgical intervention.


CONCLUSIONS
Current indications for nonoperative management, based on the results of this study, include fractures that are small, minimally displaced, and most importantly, demonstrate no evidence of elbow subluxation. The elbow joint must be congruent and demonstrate a stable ROM to a minimum of 30° of extension. For selected anteromedial coronoid fractures, nonoperative management is an option that can lead to good clinical and radiographic outcomes.
['Chan|Kevin|K|', 'Faber|Kenneth J|KJ|', 'King|Graham J W|GJ|', 'Athwal|George S|GS|']
D000328:Adult D000070628:Closed Fracture Reduction D004551:Elbow Joint D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D011403:Pronation D011859:Radiography D016059:Range of Motion, Articular D013484:Supination D011795:Surveys and Questionnaires D016896:Treatment Outcome D014458:Ulna Fractures
anteromedial coronoid coronoid fracture elbow instability varus posteromedial instability