Arthroscopic reduction and fixation of coronoid fractures with an exchange rod—a new technique

BACKGROUND The ulnar coronoid process plays a central role in maintaining elbow stability. Some of its fractures were often combined with injury of bone and ligament. Arthroscopy enables perfect visualization to allow anatomical repair. METHODS From January 2012 to December 2013, six patients (four males, two females) with a mean age of 26.6 years were treated. The left and right ulnas were involved in two and four patients, respectively. All patients suffered from ipsilateral subluxation of the elbow without associated radial fracture. According to the Regan and Morrey fracture classification and O'Driscoll's classification, two and four patients were classified as type I and type II and as having tip fracture (O'Driscoll type I) and anteromedial fracture (O'Driscoll type II), respectively. Exchange rod technology via the elbow front center approach was used for reduction and fixation of fractures of the coronoid process of the ulna. RESULTS Intra- and postoperative X-ray examination showed that the fractures were satisfactorily fixed and that the screw and fracture line were vertical to each other. Follow-ups showed that the fractures had healed well, and the average elbow extension was -2° while the average flexion was 140°. No problems related to pronation or supination, elbow instability, or complications of blood vessels or nerves were reported. The elbows showed excellent results according to the Mayo Elbow Performance Score. CONCLUSIONS Arthroscopy using an exchange rod can provide excellent visual exposure of the fractured joints, without the need for a large incision during the anatomical repair. Moreover, it protects the surrounding soft tissue, shows good stability of the components, and allows early rehabilitation exercises.