ORIF of the Coronoid Fractures

What are Coronoid Fractures?

Coronoid fractures are a break in the coronoid process of the ulna due to trauma or injury. A coronoid fracture of the ulna is a complex intraarticular fracture that is difficult to expose due to complex surrounding anatomical structures. Fractures of the coronoid rarely occur in isolation and often occurs in association with elbow dislocations and play a significant role in elbow instability. Large coronoid fractures are often linked with persistent elbow instability even after reduction of the dislocation.

What does ORIF mean?

Open reduction and internal fixation (ORIF) is a surgical technique employed for the treatment of a fracture to restore normal anatomy and improve range of motion and function.

Anatomy

The elbow joint is made up of 3 bones: the humerus (upper arm bone), the radius (forearm bone on the thumb side), and the ulna (forearm bone on the pinkie side). The upper end of the ulna presents a large C-shaped notch known as the trochlear notch that articulates with the trochlea of the humerus (upper arm bone) to form the elbow joint. The projection that forms the upper border of the trochlear notch is called the olecranon process, and the projection that forms the lower border of the trochlear notch is called the coronoid process.

Causes of Coronoid Fractures

Coronoid fractures may occur in several ways, such as:

• Fall on an outstretched arm
• Sharp or direct blow on the coronoid process of the ulna
• High-impact collision, such as motor vehicle accident
• Contact sports
• Fall on a hard surface

Signs and Symptoms of Coronoid Fractures

Signs and symptoms of coronoid fractures may include:

• Intense pain
• Swelling and bruising
• Deformity
• Numbness or weakness
• Inability to rotate arm
• Tenderness to touch

Diagnosis

When you present to the clinic with a fractured coronoid process of the ulna, your doctor will review your symptoms, perform a thorough physical examination, and may order an X-ray or CT scan to identify the type and severity of the fracture as well as injury to soft tissues.

Preparation for Coronoid Fracture Surgery

Prior to open reduction and internal fixation of the coronoid fracture, you may have:

• Physical exam to inspect blood circulation and nerves affected by the fracture
• X-ray, CT scan, or MRI scan to assess surrounding structures and broken bone
• Blood tests
• Depending on the type of fracture you have sustained, you may be given a tetanus shot if you are not up to date with your immunisations
• A discussion with an anaesthesiologist to determine the type of anaesthesia you may undergo
• A discussion with your doctor about the medications and supplements you are taking and if any should be stopped
• A discussion about the need to avoid food and drink past midnight the night prior to your surgery

Procedure for ORIF of the Coronoid Fractures

Open reduction and internal fixation is the procedure employed most often to treat severely displaced coronoid fractures.

The surgery is performed under sterile conditions in the operating room under general or local anaesthesia.

• After sterilising the affected area, your surgeon will make an incision around the elbow muscles.
• Your surgeon will locate the fracture by carefully sliding in between the muscles of the elbow.
• The cuts from the injury and surfaces of the fractured bone are thoroughly cleaned out.
• After carefully visualising the fracture, the bone fragments are first repositioned (reduced) back to their normal alignment.
• The fragments of bone are then held in place with wires, screws, pins, or metal plates attached to the outer surface of the bone.
• After securing the bone, the incisions are closed by suturing or staples and covered with sterile dressings.

Postoperative Care

You may have some pain post procedure and pain medication will be prescribed to keep you comfortable. After surgery, your arm will be placed in a short splint for support and protection. You will need to keep your arm immobile for several weeks with the aid of a sling to allow bone healing. Your doctor will provide instructions on dressings and incision care.

Physiotherapy is suggested to prevent arm stiffness, strengthen muscles, and restore range of motion. You will also be advised on a healthy diet and supplements high in vitamin D and calcium to promote bone healing.

Depending on your health condition and the extent of the injury, you may be able to go home the same day with scheduled follow-up appointments for monitoring progress and for stitches or staple removal if necessary. Your doctor will order X-rays to monitor healing throughout your treatment. Most people return to their normal activities within a couple of months.

Risks and Complications

As with any surgery, some of the potential risks and complications of open reduction and internal fixation of coronoid fractures may include:

• Bleeding
• Swelling
• Infection
• Pain
• Anaesthetic complications
• Damage to nerves and blood vessels
• Hardware irritation
• Fracture nonhealing
• Broken hardware
• Repeat surgery