Treatment of ulnar coronoid process fractures with mini-plate internal fixation via anterior elbow approach

Objective To evaluate the clinical effect of mini-plate internal fixation via anterior elbow approach in treating coronoid process fractures. Methods A retrospective case series study was conducted on the clinical data of 43 cases of ulnar coronoid process fractures treated from December 2014 to December 2016. There were 29 males and 14 females, with an average age of 32.4 years (range, 24-64 years). Twenty-four cases were injured on the right, and 19 on the left. There were 18 cases of simple coronoid process fractures, 23 combined with ipsilateral capitulum radius fractures, and two combined with ipsilateral ulna olecranon fractures. According to the O'Driscoll classification, there were four cases of type I, 3 type IIa, 9 type IIb, 17 type IIc, 6 type IIIa, and 4 type IIIb. The elbow flexion and extension range was 40°-90°[(64±18)°], and the rotation range 60°-130°[(83±15)°]. All the patients underwent mini-plate internal fixation via anterior elbow approach. The operation time, intraoperative blood loss, wound healing, fracture healing, and postoperative complications were recorded. Function of elbow joint was evaluated by Mayo elbow performance score (MEPS). Results All patients were followed up for 12-24 months (mean, 15.7 months). The average operation time was 52 minutes (range, 36-86 minutes). The average blood loss was 20 ml (range, 10-50 ml). At the last follow-up, all were seen incision healing by first intention and clinical fracture healing. The index finger, and middle finger palmaris numbness occurred in one patient after surgery, and the patient recovered at 2 months of follow up. The elbow flexion and extension range was 86°-145°[(117±114)°], and the rotation range of 114°-155°[(132±17)°], showing significant difference in comparison with the preoperative measure (P<0.05). According to the MEPS one year after operation, 14 cases were evaluated excellent, 27 good, and four fair, with an excellent and good rate of 91%. Conclusion The mini-plate internal fixation via the anterior elbow approach is effective in treating ulnar coronoid process fractures, for the operation is simple, allows full exposure, reduction, or reconstruction under direct vision, and effectively restores the function of the elbow joint. Key words: Elbow joint; Ulna fractures; Fracture fixation, internal