Arthroscopic Treatment of Anteromedial Coronoid Fracture: Complete Functional Recovery at One Year Follow Up

To prove that elbow arthroscopy is a safe, reproducible, low-invasive and effective technique to treat complex coronoid fractures The coronoid process of the ulna is a fundamental stabilizer of the elbow joint. In Complex Elbow Instabilities (CEI), coronoid fractures are associated with ligaments lesions. In the last 10 years, elbow arthroscopy has been suggested as a feasible and less invasive technique for the coronoid reduction and internal fixation. The purpose of this study was to assess the functional recovery one year after the arthroscopic treatment of coronoid fractures. Consecutive patients who underwent arthroscopic reduction and internal fixation (ARIF) of the coronoid process between 2014 and 2017 at the Orthopaedic Department of Faenza Hospital were enclosed. The inclusion criteria were anteromedial coronoid fractures (O’Driscoll type II lesions), absence of type III-IV Mason radial head fracture and 1-year minimum follow-up. We retrospectively reviewed the patients’ charts and retrieve the following data, at one year of follow up for each patient: elbow range of motion and stability (MEPS), pain (Numerical Rating Scale, NRS: 0-10), radiological consolidation and complications. Between January 2014 and December 2017, 22 patients were arthroscopically treated for coronoid fracture (7 F and 15 M, mean age 46±14y, 13 dominant sides involved): 4 cases were treated with a pull-out technique, fixed by an endobutton system, the other 18 cases underwent an ARIF with cannulated screws. Lateral collateral ligament was torn in 17 cases: we performed 16 open repairs with suture anchors and one full-arthroscopic repair with Van Riet technique. The Medial Collateral Ligament was repaired just in one case, with an open technique with suture anchor. According to MEPS, at the 1-year follow up, 20 patients reported the highest score with no residual disability, with complete range of motion and with a median pain score of 2; the radiological evaluation at final follow-up showed a successful healing in these 20 patients. The other two cases had a new upper limb trauma after the primary surgery, suffering a re-rupture inside the elbow joint, that required a new surgical treatment. No vascular or infective complications were detected at the final FU in all the cases. One case of the 20 ones that reached the primary healing, suffered elbow stiffness and ulnar nerve paresthesias after the surgery, requiring ulnar nerve open neurolysis and elbow manual release, with complete recovery. This study shows a large sample of anteromedial coronoid fractures healed after an arthroscopic treatment. Our results support the elbow arthroscopy as a safe, low-invasive surgery for coronoid process fracture, even if technically demanding.