OTA 2004 Posters
Outcome after Treatment of Coronoid Process Fractures of the Ulna
Purpose: Clinical and biomechanical studies have demonstrated the importance of the coronoid process in the stability of the ulnohumeral joint. Failure to adequately address a coronoid fracture may result in disabling elbow instability. The purpose of our study was to evaluate factors affecting the functional outcome of patients who sustained an elbow dislocation associated with a coronoid fracture. We used information acquired from medical records and two patient-based health surveys.
Methods: A retrospective study was conducted of all patients who had undergone treatment for a coronoid process fracture at our institution. Informed consent to participate in this study was obtained from all patients. Employment information, medical history, mechanism of injury, soft tissue and bone injuries, treatment, and complications were recorded from medical records. Two surveys, the SF-36v2 (general health survey) and DASH (limb-specific survey), were administered by telephone to 21 patients (75%). Univariate and multivariate analyses were performed to determine predictors of functional outcome.
Results: Twenty-eight patients were identified for inclusion in this study (18 men and 10 women) with an average follow-up time of 48 months. The mean age at time of surgery was 41 years (range, 14 to 75). Seventeen patients had a type I or II fracture; nine had a type III fracture (two were unclassified, Regan and Morrey classification). Patients treated represented a cohort of individuals who had sustained either an acute injury or for whom primary treatment was unsuccessful. Eighteen patients underwent treatment for recurrent dislocation, and 10 had at least one previous surgery.
Our results demonstrated that patients had a good-to-excellent functional outcome irrespective of the type of coronoid process fracture (mean SF-36v2 score, 75.4; SD =14.9), (mean DASH score, 21.5; SD = 14.2). The DASH was correlated with the physical function part of the SF-36 (r = -0.48, P = 0.044) as well as the SF-36 as a whole (r = -0.654, P = 0.003). Univariate analysis revealed that the presence of a lateral ligamentous tear was a strong predicator of the physical function part of the SF-36v2 (P = 0.003). Range of motion of the elbow was a strong predicator of the DASH outcome (P = 0.025). Additionally, the presence of a recurrent dislocation (P = 0.032, P = 0.004), previous surgeries on the elbow (P = 0.059, P = 0.010), and days after injury until treatment (P = 0.016, P = 0.003) were each individually strong predictors of the physical function part of the SF-36v2 and the DASH, respectively. However, when all factors were considered collectively in a multivariate analysis, no independent predictors of DASH score were found. Alternatively, a multivariable model did reveal that lateral ligamentous injury was a significant predictor of the physical function part of the SF-36v2. Patients with and without a lateral ligamentous injury achieved physical function scores of 90.5 (SD = 6.4) and 72.8 (SD = 14.8), respectively (P = 0.003).
Conclusion: Patients, on average, had good-to-excellent outcome after treatment for a coronoid fracture. Final outcomes were not related to the time to treatment, number of previous elbow surgeries, presence of a recurrent dislocation, nor coronoid fracture classification, but were related to the presence of a lateral ligamentous injury.
Significance: Functional outcome is dependent on the complexity of the overall injury pattern (in particular, the presence of a lateral ligamentous injury) and its timely management. The number of previous operations, the presence of a recurrent dislocation, and the time from injury to treatment may not affect functional outcome providing that definitive surgical treatment is well-performed. Emphasis should be placed on improving outcomes of initial management of coronoid fractures.