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Complex elbow fractures featuring a comminuted coronoid process are infrequent and pose considerable treatment challenges. The optimal strategy for maximizing recovery of elbow function through osteosynthesis remains a subject of ongoing debate among surgeons. We applied the principle of internal fixation by implementing intra-osteal fixation with a mini plate, which facilitated the successful restoration of exceptional elbow function in the patient. This approach adeptly managed the complexity of the coronoid process fracture, encompassing its fragmentation and associated injuries, thereby demonstrating its feasibility and efficacy in achieving favorable clinical outcomes. This article investigates the viability of this surgical technique for managing such complex fractures. [ABSTRACT FROM AUTHOR]

Abstract Background Approach need to be considered when surgeons dealt with complex elbow injuries and the choice of the approach is a challenge for surgeons due to the complex anatomy. On the basis of releasing the lateral collateral ligament, we modified the dislocation technique to pursue the superior exposure including not only the distal humeral surface but also the anterior facet of the coronoid process. Methods A total of 4 cadaver specimens and 8 elbows were included in the study. Each cadaver provided one elbow for either the elbow dislocation approach or the posterior olecranon approach. The exposed distal articular surface of humerus, humeral capitulum, humeral trochlea, anterior trochlea of distal humerus, posterior trochlea of distal humerus and the ulnar coronoid process surface were marked by image J software and calculated for a comparison for each surgical approach. Results The total distal humeral surface was exposed as a median of 98.2 (97.6, 99.6)% and 62.0 (58.3, 64.5)% for the elbow dislocation approach and the olecranon osteotomy approach (P

Background: Approach need to be considered when surgeons dealt with complex elbow injuries and the choice of the approach is a challenge for surgeons due to the complex anatomy. On the basis of releasing the lateral collateral ligament, we modified the dislocation technique to pursue the superior exposure including not only the distal humeral surface but also the anterior facet of the coronoid process. Methods: A total of 4 cadaver specimens and 8 elbows were included in the study. Each cadaver provided one elbow for either the elbow dislocation approach or the posterior olecranon approach. The exposed distal articular surface of humerus, humeral capitulum, humeral trochlea, anterior trochlea of distal humerus, posterior trochlea of distal humerus and the ulnar coronoid process surface were marked by image J software and calculated for a comparison for each surgical approach. Results: The total distal humeral surface was exposed as a median of 98.2 (97.6, 99.6)% and 62.0 (58.3, 64.5)% for the elbow dislocation approach and the olecranon osteotomy approach (P < 0.001), the capitulum 100% and 32.4 (28.0, 39.2)% (P < 0.001), the trochlea 93.2(90.1, 96.9)% and 72.5 (65.2, 78.8)% (P < 0.001), the anterior trochlear articular surface 96.0(93.0, 97.4)% and 50.3 (43.6, 59.1)% (P < 0.001), the posterior trochlear articular surface 95.4 (93, 100)% and 100% (P = 0.76) and the articular surface of the coronoid process of ulna 71.3 (66.0, 74.2)% and 0% (P < 0.001). Conclusion: For complex elbow fractures, the technique of elbow dislocation provides complete exposure of the distal humerus surface and a significant portion of the coronoid process surface, facilitating direct visualization for reduction and fixation. Level of evidence Anatomy Study; Cadaver Dissection. [ABSTRACT FROM AUTHOR]

Background: The treatment of complex elbow fractures implies some pitfalls and overlooked instabilities result in a poor outcome. Additional ligamentous injuries are not always obvious and require an active exclusion by computed tomography (CT), magnetic resonance imaging (MRI) or functional examination under radiographic control. Terrible triad injury: For terrible triad injuries the reconstruction or endoprosthetic replacement of the radial head, ligament refixation and in cases of persisting instability, the refixation of even small fragments of the coronoid process is recommended. Monteggia lesion: Monteggia, Monteggia-like lesions and transolecranon fracture dislocation can be managed by anatomical reconstruction of the proximal ulna and plate fixation and open reduction of the radial head is only necessary in a few cases. Essex-Lopresti fracture: There is a high risk of underestimating Essex-Lopresti fractures as a simple radial head fracture. Repair or replacement of the radial head and repositioning and retention of the distal radio-ulnar joint (DRUJ) is required. For radial head fractures a longitudinal radio-ulnar dislocation should be excluded. [ABSTRACT FROM AUTHOR]