Reconstruction for elbow instability caused by congenital aplasia of the ulnar coronoid process—a case report

© 2016 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (https://creativecommons.org/licenses/by-nc/3.0) DOI 10.3109/17453674.2015.1092064 A 13-year-old girl presented at our tertiary referral center with bilateral posterior radial head dislocation and aplasia of the ulnar coronoid process (Figure 1). She was pain-free, had a 30-degree lack of elbow extension, limited forearm pronation and supination (80–20 degrees on the right side, 80–0 degrees on the left side), but no signs of elbow instability. After several years without any relevant restrictions during her daily life activities, she returned to our outpatient clinic at the age of 17 with increasing pain on both sides and distinct radiological signs of posterior humeroulnar dislocation due to aplasia of the ulnar coronoid process (Figure 2). A review of the literature did not yield any information about that specific deformity or any possible treatment options. We decided to reconstruct the right elbow via an anteromedial approach, using a tricortical iliac crest bone graft as a coronoid equivalent and artificial bony restraint to the elbow joint. Firstly, the aplastic, cartilaginous remnant of the coronoid process was resected to form a cancellous bone ground for graft attachment. Thereafter, the bone graft was fixed with 2 cannulated 4.5-mm screws; the apophysis of the graft was orientated towards the trochlea humeri to serve as a joint surface (Figure 2). No attempt was made to reduce the dislocated radial head. However, we additionally enforced the hyperlax ulnar collateral ligaments by use of two 3.5-mm suture anchors. The anterior joint capsule was closed, the musculus brachialis was re-attached to the capsule, and finally prophy-