Varus Posteromedial Rotatory Instability of the Elbow: Injury Pattern and Surgical Experience of 27 Acute Consecutive Surgical Patients.

Objectives: To identify associated injuries that occur in varus posteromedial rotatory instability (VPMRI) of the elbow and present their surgical management.
Design: Level II retrospective study.
Setting: Tertiary referral center.
Patient/participants: Twenty-seven patients with VPMRI injuries treated surgically over an 8-year period.
Intervention: Open reduction and internal fixation of anteromedial coronoid facet fracture, lateral collateral ligament repair, and associated injured soft-tissue repairs.
Main Outcome Measured: Radiographic classification, associated medial and lateral bony and soft-tissue injuries, surgical fixation method, and complications were recorded.
Results: According to the O'Driscoll classification, there were 15 (55%) type 2-2, 11 (41%) type 2-3, and 1 (4%) type 3-1 fractures. Lateral and medial collateral ligament tears were found in 100% and 63%, respectively. Common extensor and flexor origin injuries occurred in 19 (70%) and 2 (7%) elbows, respectively. A marginal radial head fracture was found in 1 patient. Most patients were treated with a combination of fixation methods. Complications occurred in 7 (26%) patients.
Conclusions: This study documents both associated findings and surgical fixation methods. In all cases, the lateral collateral ligament was disrupted, often in association with an injured common extensor origin. Medial collateral ligament injuries are commonly involved. Radial head fractures are rarely associated. The surgeon should have a high index of suspicion if an isolated coronoid fracture is encountered. Clinical and functional outcome scores are needed in future studies to further inform treatment of VPMRI of the elbow.
Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.