The coronoid is one of the elbow’s primary static stabilisers, and the importance of reconstruction following fracture with instability has been established. In the developing elbow, instability can lead to greater sigmoid notch dysplasia that can make reconstruction challenging. A novel technique to improve osseous stability with an opening wedge ‘stamp osteotomy’ reconstruction of the coronoid is described combined with a lateral ligament reconstruction, in two patients with recurrent posteromedial rotatory instability. The technique improves congruity and coverage of the greater sigmoid notch with the trochlea whilst maintaining articular cartilage. Extra-articular iliac crest bone graft is used to maintain the position with buttress plate support. The surgical technique is described and the clinical and radiographic outcome reported in two patients. Level of evidence: IV.
DeutchSRJensenSLOlsenBS, et al.Elbow joint stability in relation to forced external rotation: an experimental study of the osseous constraint. J Shoulder Elbow Surg2003; 12: 287–292.
2.
MorreyBFAnKN. Stability of the elbow: osseous constraints. J Shoulder Elbow Surg2005; 14: 174S–178S.
3.
SteinmannSP. Coronoid process fracture. J Am Acad Orthop Surg2008; 16: 519–529.
4.
BeingessnerDMDunningCEStacpooleRA, et al.The effect of coronoid fractures on elbow kinematics and stability. Clin Biomech2007; 22: 183–190.
5.
PollockJWBrownhillJFerreiraL, et al.The effect of anteromedial facet fractures of the coronoid and lateral collateral ligament injury on elbow stability and kinematics. J Bone Joint Surg Am2009; 91: 1448–1458.
6.
ReganWMorreyB. Fractures of the coronoid process of the ulna. J Bone Joint Surg Am1989; 71: 1348–1354.
7.
O'DriscollSWJupiterJBCohenMS, et al.Difficult elbow fractures: pearls and pitfalls. Instr Course Lect2003; 52: 113–134.
8.
PhadnisJWattsACoronoid process fractures and plate fixation. In: BainGEygendaalDvan RietR (eds). Surgical techniques for trauma and sports related injuries of the elbow, Berlin: Springer, 2020.
9.
O'Driscoll SW. Classification and evaluation of recurrent instability of the elbow. Clin Orthop Relat Res 2000: (370): 34–43.
10.
CloughTMJavedABaleRS. Recurrent elbow instability in a child: a case report. J Shoulder Elbow Surg2000; 9: 441–442.
11.
LattanzaLLKeeseG. Elbow instability in children. Hand Clin2008; 24: 139–152.
12.
Gianoutsos MP, Beard A and Tonkin MA. Joint laxity. In: Gupta A, Kay S and Scheker LR (eds) The growing hand: diagnosis and management of the upper extremity in children. London: Harcourt, 1999, pp.415–420.
13.
GoldfarbCAPattersonJMMSutterM, et al.Elbow radiographic anatomy: measurement techniques and normative data. J Shoulder Elbow Surg2012; 21: 1236–1246.
14.
MatzonJLWidmerBJDraganichLF, et al.Anatomy of the coronoid process. J Hand Surg2006; 31: 1272–1278.
15.
AbloveRHMoyOJHowardC, et al.Ulnar coronoid process anatomy: possible implications for elbow instability. Clin Orthop Relat Res2006; 449: 259–261.
16.
ReichelLMMilamGSHillinCD, et al.Osteology of the coronoid process with clinical correlation to coronoid fractures in terrible triad injuries. J Shoulder Elbow Surg2013; 22: 323–328.
17.
RafehiSLaloneEJohnsonM, et al.An anatomic study of coronoid cartilage thickness with special reference to fractures. J Shoulder Elbow Surg2012; 21: 961–968.
18.
GriffithA. Therapist’s management of the stiff elbow. Rehab Hand Upper Extremity2002; 2: 1245–1262.
19.
O'DriscollSWBellDFMorreyBF. Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am1991; 73: 440–446.
20.
KarbachLEElfarJ. Elbow instability: anatomy, biomechanics, diagnostic maneuvers, and testing. J Hand Surg Am2017; 42: 118–126.
21.
Watts AC, Singh J, Elvey M, et al. Current concepts in elbow fracture dislocation. Shoulder Elbow. Epub ahead of print 2019. DOI: 10.1177/1758573219884010.
22.
MoritomoHTadaKYoshidaT, et al.Reconstruction of the coronoid for chronic dislocation of the elbow. Use of a graft from the olecranon in two cases. J Bone Joint Surg Br1998; 80: 490–492.
23.
BellTHFerreiraLMMcDonaldCP, et al.Contribution of the olecranon to elbow stability: an in vitro biomechanical study. J Bone Joint Surg Am2010; 92: 949–957.
24.
AlolabiBGrayAFerreiraLM, et al.Reconstruction of the coronoid process using the tip of the ipsilateral olecranon. J Bone Joint Surg Am2014; 96: 590–596.
25.
BellatoERotiniRMarinelliA, et al.Coronoid reconstruction with an osteochondral radial head graft. J Shoulder Elbow Surg2016; 25: 2071–2077.
26.
RingDGussDJupiterJB. Reconstruction of the coronoid process using a fragment of discarded radial head. J Hand Surg Am2012; 37: 570–574.
27.
EsserRD. Reconstruction of the coronoid process with a radial head fragment. Orthopedics1997; 20: 169–171.
28.
van RietRPMorreyBFO’DriscollSW. Use of osteochondral bone graft in coronoid fractures. J Shoulder Elbow Surg2005; 14: 519–523.
29.
SilveiraGHBainGIEngK. Reconstruction of coronoid process using costochondral graft in a case of chronic posteromedial rotatory instability of the elbow. J Shoulder Elbow Surg2013; 22: e14–18.
30.
ChungCHWangSJChangYC, et al.Reconstruction of the coronoid process with iliac crest bone graft in complex fracture-dislocation of elbow. Arch Orthop Trauma Surg2007; 127: 33–37.
