Anatomy of Coronoid Process of Ulna.
While fracture of olecronon is very common, fracture of oronoid process is seen less commonly. Fractures of the coronoid process usually reflect severe trauma to the elbow.
Previously, it was thought that these fractures were as a result of avulsion force acting on coronoid but now it is thought that they probably are due to direct impact of trochlea on the cornoid when force acts.
The brachialis muscle,which was thought to put force of avulsion inserts much distally than the tip of the coronoid. However, it is not uncommon to find attached fibers of brachialis in a larger fragment distal to the coronoid process.
When the fragment of coronoid is large, it may cause dislocation of the elbow as the supportive buttress is no longer available [See classification]. But a a small coronoid potentially severe trauma with possible acute recurrent dislocation.
Classification of fracture
The classification was suggested by Regan and Morrey who after a retrospective study,classified the fracture into three types .
Classification of fractures of coronoid process
Type I—small avulsion fracture at tip of coronoid
Type II—fragment involves 50% of the coronoid but does not extend to the base
Type III—fracture at the base of the coronoid, likely including the insertions of the brachialis and the anterior band of the medial collateral ligament.
Inspite oof their type, the presence of a coronoid fracture should evoke concern for acute instabilit.
Treatment
Fracture of coronoid process are generaaly not amenable to closed treatment. Therefore open reduction is almost always treatment of choice where the fragment is stabilized using either screw or wire fixation.
Because they are generally associated with elbow instability, open reduction with internal fixation of a significant coronoid fracture often provides the necessary stability to prevent further dislocation.
Operative intervention may also be considered for those fractures that interfere with joint motion. This can occur if the fragment is intraarticular or if it unites proximally and forms a significant bone block to flexion.
After the surgery, the limb is immobilized for a period of 3 to 4 weeks. Weekly follow up should be done with xray.
After this period , gentle elbow mobilisation is begun.
Hello, I am writing because I have been treated for tennis elbow for over one year now. I have had a total of 3 cortizone shots in that period of time. I was laid-off over a year ago and have been a server ever since. After my last injection, the pain became unbearable as it wore off rather quickly. I had been taken tylenol, etc. to help with the pain during my injection periods as that did not fully help. As I said, my pain has been quite severe, no range of motion, no sleep and my children have been helping me dress… Ugh. I have missed much work because I was not able to serve properly and ended up back at the doctors office. By off chance, my doctor was not in that day so I had to see someone else. My arm and fingers were swollen and I was in severe pain. My original doctor prescribed me Tramadol (didn’t even touch the pain). When I saw the other doctor, he asked me if they had taken any x-rays when I was diagnosed. He looked at me quite bewildered when I told him no…
He had me take some x-rays and off I went with a prescription for Oxycodone. I later ended up in the ER. Just couldn’t take it anymore. I pride myself on a high pain tolerance, but this was out of hand. He agreed with the other doctor and said I needed to go back to the Orthopedic as soon as possible. I ended up with a prescription of Valium as well. Now I am in an induced coma…. atleast it feels that way. Yes, I am very careful with my prescriptions. Anyhow, I got a call Monday morning from the nurse who told me I needed to take these x-rays w/ me to the Ortho ASAP. I asked why and she told me I have had a “small avulsion fracture noted off the coronoid process of the proximal right ulna”. Grrrrrr…….I have been living with this pain for over a year now and I am wondering if it is even fixable at this point? What process do you think will take place, and, will this be permanent? Any ideas as I am desperate at this point. The Ortho can’t get me in until April 4th, even with a mis-diagnosis…. Please help me with some advice. It is so greatly appreciated. Thanks ahead of time from a hard-working mom who’s in school full time and can’t write her own essays. By the way, I am going for my nursing degree, will I be able to continue this degree with my elbow?
Dr Arun Pal Singh Reply:
March 31st, 2011 at 1:42 pm
@Jennifer Rodriguez,
There are two things that I can get from your writing
1] You were treated for Tennis elbow
2] There is a small avulsion fracture in your coronoid on the same side.
First, a small old [probably] coronoid fracture would not cause that much pain.
And at the same time, tennis elbow responds very well to steroid injections. You would have intermittent periods of few dayswhere you should be symptom free.
Please see your specialist. Things would become clearer then.