History and Physical Examination

Coronoid fractures are usually seen in patients with elbow dislocations. The patient usually presents with a history of a fall on the outstretched hand and a deformity of the elbow.

The presence of an unstable reduction is suggestive of an associated coronoid or radial head fracture. An irreducible dislocation, on the other hand, should arouse suspicion of soft-tissue (brachialis, median nerve) or bony (medial epicondyle) interposition in the joint.

Distal vascularity and neurologic status should always be tested in these cases.

In children, coronoid fractures have a bimodal age distribution, with peaks at age 8-9 years and at age 12-14 years.^[24] Coronoid fractures in children are often associated with elbow dislocations, olecranon fractures, medial epicondyle fractures, or lateral condyle fractures.

In children younger than 6 years, Blasier described an unusual flap injury of the unossified coronoid in which the elbow is dislocated and a small flap of the articular surface gets flipped back into the joint.^[25] This usually appears on the lateral radiograph as a small flake of bone in the anterior portion of the joint. This flake is a clue to the underlying pathoanatomy and the extent of injury.

Workup

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Media Gallery

Elbow joint, anterior view.
Elbow joint, posterior view.
Type 2 coronoid fracture: unstable elbow fracture dislocation with fracture involving <50% of coronoid height and associated radial head fracture.
Type 3 coronoid fracture: fracture involving >50% of coronoid height.
Type 1 coronoid fracture: avulsion fracture at tip of coronoid.
Status post open reduction and internal fixation of coronoid with plate-and-screw construct. Courtesy of Kenneth Egol, MD.
Status post open reduction and suture fixation of coronoid, as evidenced by drill holes in proximal ulna. Sutures are used as a lasso to capture coronoid fragment, passed through ulnar drill holes, and tied over posterior ulna bony bridge. Patient is also status post radial head replacement for comminuted radial head fracture. This is an example of typical operative management of "terrible triad" elbow injuries.
Second example of plate-and-screw constructs for fixation of type 3 coronoid fracture. Courtesy of Kenneth Egol, MD.
Chronic elbow fracture dislocation presentation films with type II coronoid fracture (left) and fixation films (right). Fixation consisted of radial head replacement and suture lasso fixation of coronoid fracture. Since the elbow remained unstable throughout the range of motion, a hinged external fixator was placed.

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Author

Nirmal Tejwani, MD, MPA Professor of Orthopedic Surgery, New York University Hospital for Joint Diseases; Chief of Orthopedic Trauma, Bellevue Hospital

Nirmal Tejwani, MD, MPA is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, AO Foundation, Orthopaedic Trauma Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Orthopedic Trauma Association Board of directors.<br/>Received honoraria from Stryker for speaking and teaching; Received honoraria from Zimmer for speaking and teaching; for: Stryker; Zimmer.

Coauthor(s)

Nicole Stevens, MD Resident Physician, Department of Orthopedics, NYU Langone Medical Center

Nicole Stevens, MD is a member of the following medical societies: American Medical Student Association/Foundation, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert J Nowinski, DO Clinical Assistant Professor of Orthopaedic Surgery, Ohio State University College of Medicine and Public Health, Ohio University College of Osteopathic Medicine; Private Practice, Orthopedic and Neurological Consultants, Inc, Columbus, Ohio

Robert J Nowinski, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, Ohio State Medical Association, Ohio Osteopathic Association, American College of Osteopathic Surgeons, American Osteopathic Association

Disclosure: Received grant/research funds from Tornier for other; Received honoraria from Tornier for speaking and teaching.

Chief Editor

Murali Poduval, MBBS, MS, DNB Orthopaedic Surgeon, Senior Consultant, and Subject Matter Expert, Tata Consultancy Services, Mumbai, India

Murali Poduval, MBBS, MS, DNB is a member of the following medical societies: Association of Medical Consultants of Mumbai, Bombay Orthopedic Society, Indian Orthopedic Association, Indian Society of Hip and Knee Surgeons

Disclosure: Nothing to disclose.

Additional Contributors

Steven I Rabin, MD, FAAOS Clinical Associate Professor, Department of Orthopedic Surgery and Rehabilitation, Loyola University, Chicago Stritch School of Medicine; Medical Director, Musculoskeletal Services, Dreyer Medical Clinic

Steven I Rabin, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Fracture Association, American Orthopaedic Association, AO Foundation, Chicago Metropolitan Trauma Society, Illinois Association of Orthopaedic Surgeons, Limb Lengthening and Reconstruction Society, Mid-America Orthopaedic Association, Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho Associate Professor of Orthopedic Surgery and Pediatrics, Jefferson Medical College of Thomas Jefferson University; Consulting Staff, Department of Pediatric Orthopedic Surgery, Alfred I duPont Hospital for Children; Orthopedic Oncologist, Helen F Graham Cancer Center and Christiana Care Health Services

Mihir M Thacker, MBBS, MS(Orth), DNB(Orth), FCPS(Orth), D'Ortho is a member of the following medical societies: Children's Oncology Group, Medical Council of India, Musculoskeletal Tumor Society, Pediatric Orthopaedic Society of North America, Limb Lengthening and Reconstruction Society

Disclosure: Nothing to disclose.

Coronoid Fracture Clinical Presentation

History and Physical Examination

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