Correlation between fragment size of ulnar coronoid process fracture and patient prognosis / 中华创伤骨科杂志

Objective:To investigate the relationship between fragment size of ulnar coronoid process fracture and patient prognosis.Methods:A retrospective study was conducted of the 34 patients who had been treated at Department of Orthopaedics, The Second Hospital Affiliated to Lanzhou University for fracture of ulnar coronoid process combined with elbow dislocation from July 2016 to December 2020. They were assigned into 2 groups according to their different treatments. In the surgery (internal fixation) group of 23 cases, there were 15 males and 8 females, aged from 22 to 71 years; in the conservative treatment group of 11 cases, there were 8 males and 3 females, aged from 38 to 78 years. Preoperatively, the sizes of coronoid process and fracture fragments were measured by elbow CT scan and 3D reconstruction, and a size-weighted ratio Z (%) corresponding to the fragment of coronoid process fracture was calculated. At the last follow-up, American Hospital for Special Surgery total elbow scoring system (HSS2) score was used to assess their therapeutic efficacy, the correlation between the ratio Z and HSS2 score for elbow function was calculated, and complications were recorded.Results:There were no significant differences between the surgery and conservative treatment groups in gender or age ( P>0.05). All the 34 patients were followed up for 18 to 54 months (average, 36.7 months). At the last follow-up, the HSS2 score was 93.77±0.84 (from 82 to 98) for the surgery group and 86.00±1.42 (from 78 to 90) for the conservative treatment group; the complications rate was 13.04% (3/23) for the former and 63.64% (7/11) for the latter. There was a linear relationship between the size-weighted ratio Z of the coronoid fracture fragment and the HSS2 elbow function score in the surgery group ( P<0.01). The linear regression equation between them was: y=99.44-0.121x ( r2=0.86, P<0.01). There was a linear relationship between the size-weighted ratio Z of the coronoid fracture fragment and the HSS2 elbow function score in the conservative treatment group ( P<0.01). The linear regression equation between them was: y=89.46-0.144x ( r2=-0.91, P<0.01). When a HSS2 elbow joint function score 90 was substituted into both linear regression equations, the results were x=78.02 for the surgery group and x=3.75 for the conservative treatment group. Conclusions:Conservative treatment may not lead to a satisfactory prognosis for the patients with coronoid process fracture whose size-weighted ratio of fracture fragment is larger than 3.75. Open reduction and internal fixation usually leads to a satisfactory prognosis for those whose size-weighted ratio of fracture fragment is smaller than 78.02.

Effects on Elbow Stability of the Terrible Triad Using Medial Collateral Ligament Repair and Ulnar Coronoid Process Fixation / 医用生物力学

Objective To investigate the effect of medial collateral ligament (MCL) repair and coronoid process fracture fixation on stability of the Terrible Triad of the elbow. Methods CT and MRI scan images of elbow joints from one healthy 28-year-old male volunteer were used to establish three elbow models. Model A: normal model. Model B: repair of coronoid process fractures, without MCL repair. Model C: repair of MCL, without repair of ulnar coronoid processes. Longitudinal loads were applied on the three models to analyze the displacement and stress distributions of the elbow joint under different working conditions and compare the stability of the elbow joint. Results The displacement and stress distributions of the three models were similar. The maximum displacement and maximum stress of the articular surface were located at the ulna pulley notch, while the minimum displacement was located at the coronoid process and its medial side. The minimum stress was located at the lower lateral side of the coronoid process. There were no statistical differences in the maximum displacement and stress among the three models (P>0.05). Conclusions When the lateral column is stable, the effect of repairing the MCL and fixing the fracture block of ulnar coronoid process is similar.

Treatment of ulnar coronoid process fracture via a modified anteromedial approach / 中国修复重建外科杂志

Objective: To investigate the effectiveness of a modified anteromedial approach in the treatment of ulnar coronoid process fracture. Methods: Between February 2017 and July 2018, 15 patients with ulna coronoid process fracture were reviewed. There were 9 males and 6 females, with an average age of 42.3 years (range, 24-60 years). The causes of injury included falling in 10 cases and traffic accidents in 5 cases, all cases were closed injury. According to the O'Driscoll classification, there were 4 cases of type Ⅰ, 6 cases of type Ⅱ, and 5 cases of type Ⅲ. The time from injury to operation was 2-8 days (mean, 3.7 days). All fractures were treated via a modified anteromedial approach between the pronator teres and the flexor carpi radialis plus with partial incision of flexor tendon aponeurosis. The fracture healing, muscle strength of forearm, postoperative complications were observed. At last follow-up, the elbow mobility were measured, the function of elbow was evaluated by Mayo elbow performance score (MEPS). Results: All cases were followed up 10-18 months (mean, 13.3 months). Fracture union was achieved in all patients with a mean time of 10 weeks (range, 8-14 weeks). No obvious decrease of hand grip strength, nerve injury, and infection occurred. One patient had slight heterotopic ossification without special treatment. At last follow-up, all patients had stable elbows with good flexion-extension and varus-valgus stability, the mean flexion was 123.3° (range, 100°-140°), mean extension loss compared with that before operation was 6.7° (range, 0°-20°), mean pronation was 76.0° (range, 60°-85°), and mean supination was 75.8° (range, 55°-90°). The MEPS score was 65-100 (mean, 90.3) with the result of excellent in 10 cases, good in 4 cases, and fair in 1 case. Conclusion: The treatment of ulnar coronoid process fracture via the modified anteromedial approach provides excellent exposure, minimal invasion, fewer complications, and satisfactory prognosis, which is conducive to elbow joint function recovery.

Treatment of ulnar coronoid process fractures in complex elbow injury with plate fixation through an anterior approach / 中国组织工程研究

BACKGROUND: Ulnar coronoid process has special anatomy and it is adjacent to vascular nerve. It is characterized by weak fixation, unstable recurrence, postoperative elbow joint stiffness and pain. These make the treatment of ulnar coronoid process fracture, in particular in complex elbow joint injuries, challenged. OBJECTIVE: To investigate the efficacy of internal fixation with steel plate through an anterior approach on ulnar coronoid process Regan-Morrey type II or type III fracture in complex elbow injury METHODS: Sixteen patients with complex elbow injury and ulnar coronoid process fractures who underwent open reduction and internal fixation were followed up between September 2012 and May 2017. Among these patients, 11 patients had Regan-Morrey type II fracture, 5 patients had Regan-Morrey type III fracture, 14 patients had humeral head fracture, and 2 patients had ulnar olecranon fracture. All patients provided written informed consent. This study was approved by the Medical Ethics Committee of Hong Hui Hospital, China. Ulnar coronoid process fractures were reduced and fixed with steel plate through the space between the median nerve and the radial artery using an anterior approach. At the same time, all radial humeral head and olecranon fractures were treated by internal fixation. RESULTS AND CONCLUSION: All patients acquired acceptable reduction and firm fixation of fractured fragments. All of them were followed up for 13-28 months. At the final follow-up, solid osseous union was confirmed for all coronoid fractures. The average time to radiologic union was 16.5 weeks. The mean flexion-extension arc was 113.4°, the flexion contracture was 13.8°, and further flexion was 127.2°. The mean pronation arc was 72.5°. The mean supination arc was 74.7°, and the mean forearm rotation arc was 146.9°. 11 patients achieved functional arc of motion. All patients were satisfied with the treatment with the mean Mayo Elbow Performance score of 90.3 points. 11 patients achieved excellent elbow performance and 5 patients achieved good elbow performance. These results suggest that ulnar coronoid process fractures in complex elbow injury can be treated successfully with an anterior surgical approach. This approach allows for accurate and rigid internal fixation with steel plate and early functional exercise, resulting in a reasonable outcome.

Long-term effects of autogenous coronoid grafts on the facial growth of children with unilateral temporomandibular joint ankylosis and reconstructed mandibular condyle / 华西口腔医学杂志

OBJECTIVE@#Mandibular condyle injury usually results in malocclusion and disharmony of facial growth in growing children. This study aimed to evaluate the long-term effects of autogenous coronoid grafts on the facial growth of children with unilateral temporomandibular joint (TMJ) ankylosis who underwent mandibular condyle reconstruction.@*METHODS@#Ten growing patients with unilateral bony TMJ ankylosis admitted in West China Hospital of Stomatology, Sichuan University between January 1st, 2008 and December 31st, 2016 were followed up and evaluated. These patients include three males and seven females with ages ranging from 5 years to 12 years at the time of surgery. Each patient underwent gap arthroplasty, condyle reconstruction with ipsilateral coronoid, and interposition of the pedicled temporalis fascial flap in a single operation. The postoperative follow-up ranged from 3 years to 8 years with an average of 4.9 years. Postoperative panoramic radiographs determined the growth of the mandibular height and length on the affected side and compared it with those of the healthy side.@*RESULTS@#All patients recovered uneventfully after surgery. At the end of follow-up period, the maximal mouth opening ranged from 32 mm to 41 mm with an average of 35.6 mm. Mandibular height and length continued to grow after the successful treatment of ankylosis using autogenous coronoid grafts for condyle reconstruction. However, growth deficit still existed. The final ramus height and mandibular length of the affected side at the end of follow-up increased by 25.3% (P<0.05) and 26.1% (P<0.05), respectively, compared with the initial values measured immediately after surgery. Growth rates of ramus height and mandibular length of the affected side were 47.1% and 27.2% lower (P<0.05) than those of the healthy side, respectively.@*CONCLUSIONS@#Mandibular height and length continued to grow after the successful treatment of ankylosis by using autogenous coronoid grafts for condyle reconstruction. However, growth deficit still existed. The growth rate of the affected mandible was reduced compared with that of the undisturbed side even after treatment of ankylosis.

A morphometric study of mandibular foramen in dry adult human mandibles of indian population in telangana state

Background: Mandibular foramen is an irregular foramen located just above the centre of the medial surface ofthe ramus of the mandible. Mandibular foramen is leading to mandibular canal through which inferior nerveand vessels will transmit and supply the teeth of lower jaw.The Mandibular foramen is an important anatomical landmark for the inferior nerve blocks, mandibularosteotomies and implant treatment. The inferior nerve block is the commonest local anaesthetic techniquewhich is used for anaesthetizing lower jaw in various surgical and dental procedures on mandible andmandibular teeth such as removal of impaction, reduction of fractures and tooth extraction. Inferior alveolarnerve block failure is not uncommon and it occurs even with experienced hands due to variations in position ofmandibular foramen.A thorough knowledge of anatomy of mandibular foramen is very essential hence aim of this study was todetermine the exact position of mandibular foramen by studying dry adult human mandibles of telanganapopulation.Material and methods: The present study was conducted using 60 dry adult human mandibles obtained fromanatomy department of Shadan institute of medical sciences,Hyderabad and VRK womens medicalcollege,Hyderabad. The data was tabulated and statistically analysed.Result: The mean distance of mandibular foramen to anterior border of ramus (MF-AB)was16.67±2.73mm(R)and16.56±2.52mm(L),to posterior border of ramus(MF-PB) was 12.67±2.37mm(R) and 13.03±2.43mm(L),to mandibularnotch (MF-MN) 21.04±2.95mm(R) and 20.24±2.94mm(L),to angle of mandible was 23.005±3.92mm(R) and22.36±3.89mm,base of mandible or inferior border (MF-MB) was 24.38±3.86mm(R) and 24.42±4.44mm(L), tip ofcoronoid process (MF-CrT) 35.68±3.25mm(R) and 35.19±3.47mm (L).Conclusion: The present study gives a fair knowledge of the position of mandibular foramen and provides usefulinformation for successful local anaesthesia ( inferior nerve block),to the maxillofacial surgeons,radiologistsand oncologists performing operations on the mandible to prevent complications and misinterpretations

Buttress plate fixation of coronoid process fractures via a medial approach / 中华创伤杂志(英文版)

PURPOSE@#To assess the clinical and radiographic outcomes of coronoid process fractures surgically managed with buttress plate fixation via a medial approach.@*METHODS@#A retrospective review of all coronoid fractures surgically fixed in our institution using a buttress plate technique via a medial approach between June 2012 and April 2015 by the senior author was performed. These fractures were all sizeable fractures contributing to persistent elbow instability in terrible triad or varus posteromedial rotatory instability injury patterns. A prospective telephone questionnaire was conducted to assess patient outcomes using the disabilities of the arm, shoulder and hand (DASH) score and Mayo hlbow performance score (MEPS).@*RESULTS@#Twelve patients were included in the study, comprising 10 males and 2 females with an average age of 39 years (range, 19-72 years). Mean follow-up was 16 months (range, 4-18 months). The average time to radiographic union was 4 months (range, 3-7 months). Range of motion measurements at final follow-up were obtained in 11 out of 12 patients, with one patient defaulting follow-up. All 11 patients displayed a functional elbow range of motion of at least 30°-130°, with an average arc of motion of 130° (range, 110° -140°), mean elbow flexion of 134° (range, 110° -140°) and mean flexion contracture of 3° (range, 0° -20°). The mean DASH score was 16 (range, 2.5-43.8) and the mean MEPS was 75 (range, 65-100). Complications observed included one patient with a superficial wound infection which resolved with a course of oral antibiotics and one patient with radiographic evidence of heterotopic ossification which was conservatively managed. No residual elbow instability was observed and no reoperations were performed.@*CONCLUSION@#Buttress plate fixation via a medial approach of coronoid process fractures that contribute to persistent elbow instability represents a reliable method of treatment that produces satisfactory and predictable outcomes.

Tratamento cirúrgico da limitação de abertura bucal causada por hiperplasia do processo coronoide: relato de caso / Surgical treatment for mouth opening limitation caused by coronoid process hyperplasia: case report

A hiperplasia do processo coronoide é uma condiçãoincomum de etiologia desconhecida que se apresentaclinicamente por meio da limitação de abertura bucal enão possui sintomatologia dolorosa durante a aberturae o fechamento bucal. Objetivo: relatar e discutir, pormeio de um caso cirúrgico, o tratamento da limitaçãode abertura bucal causada por hiperplasia bilateral doprocesso coronoide. Relato de caso: paciente do sexofeminino, com 11 anos de idade, foi encaminhada paraatendimento devido à dificuldade de mastigação emfunção da limitação de abertura bucal, sem históricode trauma em face ou na região articular. O exame tomográficoevidenciou o alongamento bilateral do processocoronoide, fazendo com que ele colidisse com oarco zigomático durante a abertura bucal e causasse otravamento. O tratamento proposto foi a coronoidectomiabilateral com acesso cirúrgico intraoral, obtendono pós-cirúrgico imediato um ganho na abertura bucal.Considerações finais: a coronoidectomia é uma abordagemcirúrgica de fácil acesso por via intraoral, poucotraumática e eficaz no tratamento de pacientes com hiperplasiado processo coronoide. (AU)

The coronoid process hyperplasia is an unusual condition of unknown etiology that is presented clinically through mouth opening limitation, without painful symptoms during mouth opening and closure. Objective: to report and discuss, through a surgical case, the treatment of mouth opening limitation caused by bilateral coronoid process hyperplasia. Case report: female patient, 11 years old, referred due to chewing difficulty by mouth opening limitation. No history of trauma in the face or joint area. The tomographic examination showed the bilateral elongation of the coronoid process, causing it to collide with the zygomatic arch during mouth opening, which caused locking. The treatment proposed was bilateral coronoidectomy with intraoral surgical access, which enhanced mouth opening at the immediate postoperative period. Final considerations: coronoidectomy is a surgical approach with easy intraoral access, non-traumatic, and effective in the treatment of patients with coronoid process hyperplasia. (AU)

Bilateral hyperplasia of the coronoid process: clinical case report with unusual presentation and literary review

The formation of a new joint between a pathologically enlarged coronoid process and the body of the malar bone is known as Jacob's disease. hyperplasia of the coronoid process was first described in 1853 by von Langenbeck, and it was not until 1899 when Oscar Jacob described the disease that was named after him. Jacob's disease is an uncommon entity with only a few cases documented in the literature. the condition manifests at first with progressive limitation of the oral opening and facial asymmetry. the pain is infrequent and mainly affects young patients. temporal muscle hyperactivity, cranial trauma, chronic displacement of the ipsilateral temporomandibular joint, endocrine stimuli and genetic alterations have been postulated as possible factors. the definitive diagnosis is by histopathology and it is necessary that bone hyperplasia is confirmed, as well as the presence of cartilage and synovial capsule forming the new joint between the malar bone and the coronoid process. we present a 10-year-old patient with a history of childhood trauma in the left preauricular region. it presented to our service with a history of progressive limitation of the oral opening. computed tomography (CT) revealed an elongation of the bilateral coronoid process, in contact with homolateral zygomatic bone, causing its deformation. surgery under general anesthesia was performed through the intraoral vestibular route. histopathology confirmed the diagnosis of Jacob's disease. we review the literature regarding the etiology, pathogenesis, clinical characteristics, diagnosis and treatment of this condition.

Clinical study of the removal of infratemporal fossa and pterygopalatine fossa foreign bodies using a trans-oral approach / 口腔疾病防治

Objective @#To summarize the clinical experience of removing infratemporal fossa and pterygopalatine fossa foreign bodies via a trans-oral approach. @* Methods@#The clinical data of 9 patients with foreign bodies in the infratemporal fossa and pterygopalatine fossa hospitalized from March 2008 to June 2017 were analyzed retrospectively. Among these cases, 4 were flying injuries, 2 were falling injuries, 2 were traffic injuries and 1 was an iatrogenic syringe injury. Foreign bodies were divided into the following categories: 3 cases of wood from branches, 3 cases of iron filings, 2 cases of broken glass, and one case of a broken syringe needle. Before surgery, all subjects underwent spiral CT three-dimensional reconstruction and CT angiography examinations. After accurately determining the relationship between the foreign body and the internal and external carotid arteries and their branches, patients underwent an operation under general anesthesia to remove the foreign body via a trans-oral approach. In addition, patients participated in mouth opening training for one week. Then, patients were followed for 1 to 6 months. Foreign bodies were removed completely in all 9 patients.@*Results@#Foreign bodies were independently located in the pterygopalatine fossa in 2 cases and in the in fratemporal fossa in 3 cases. There were 4 cases of foreign bodies located in both the infratemporal fossa and the pterygopalatine fossa. All 9 patients had the foreign bodies completely removed and were discharged one week after surgery. They were followed for 1 to 6 months. Their mouth opening and occlusion were normal, without any complications.@*Conclusion @#Spiral CT, 3D reconstruction and CT angiography examinations are necessary and important for accurate pre-operation positioning. It is feasible to remove foreign bodies in the infratemporal fossa and pterygopalatine fossa via a trans-oral approach.

Comparative study on effect of coronoid fixation with lateral collateral ligament repair versus hinged external fixator in treatment of elbow varus posteromedial rotational instability / 中华创伤杂志

Objective To compare the effect of coronoid fixation combined with lateral collateral ligament repair versus hinged external fixator in treatment of elbow varus posteromedial rotational instability.Methods This retrospective cohort research included 34 patients with elbow varus posteromedial rotational instability operated between January 2011 and June 2015.All patients had coronoid process fractures of O'Driscoll type Ⅱ[(six with subtype 1,24 with subtype 2 and four with subtype 3).Fifteen of the 34 patients were operated by coronoid fixation combined with lateral collateral ligament repair (Group A) and other 19 patients were operated by coronoid fixation combined with placing hinged external fixator (Group B).Interval between injury and operation,operation time and blood loss were recorded.At final follow-up,elbow range of motion,Mayo elbow performance score (MEPS) and Hastings and Graham heterotopic ossification classification were measured.Results There were no significant differences in the interval between injury and operation,operation time and blood loss between the two groups (P ＞0.05).Median period of follow-up was 30 months in Group A and 40 months in Group B.Last follow-up showed flexion of the affected elbow in Group B [145° (135°-150°)] was better than that in Group A [140° (130°-145°)] (P ＜ 0.05),while between-group differences were insignificant in elbow extension,elbow extension-flexion,forearm pronation-supination and heterotopic ossification classification (P ＞ 0.05).MEPS in Group A scored 100 in 10 patients,90 in three,85 in one and 70 in one;MEPS in Group B scored 100 in 13 patients,90 in one,85 in four and 80 in one.There was no significant difference in MEPS between the two groups (P ＞ 0.05).Conclusion For treating elbow varus posteromedial rotational instability,either lateral collateral ligament repair or hinged external fixation after anatomic reduction and coronoid fixation can achieve good results.

Coronoid impingement syndrome: literature review and clinical management / 대한악안면성형재건외과학회지

BACKGROUND: This case report discusses the unusual presentation of limited mouth opening as a result of bilateral coronoid process hyperplasia. CASE PRESENTATION: A 14.5-year-old male patient of white Caucasian ethnicity presented with limited mouth opening, mandibular asymmetry, and dental crowding. Investigations confirmed bilateral coronoid process hyperplasia and management involved bilateral intraoral coronoidectomy surgery under general anaesthesia, followed by muscular rehabilitation. Mouth opening was restored to average maximum opening within 4 months of surgery. CONCLUSION: Limited mouth opening is a common presentation to medical and dental professionals. The rare but feasible diagnosis of coronoid impingement syndrome should not be overlooked.

Treatment of the old terrible triad of the elbow without operative history / 北京大学学报(医学版)

Objective:To introduce the surgical techniques and treating results of the old “terrible triad”of the elbow.Methods:A retrospective analysis of 1 1 cases of old “terrible triad”of the elbow treated by the author from March 2009 to February 2014 were performed,with 9 males and 2 females;mean age was (31.82 ±8.66)years (17-45 years).The average time after injury was (6.36 ±2.50) weeks (4-12 weeks),with 7 cases on the left and 4 right.The combined injury included 2 cases with distal radius fractures,1 with ankle fractures,fractures of the distal radius and the head injury (minor epidural hematoma,no surgery),and 1 with Pilon fractures and L4 fractures (fixed at local hospital). All the patients had elbow stiffness and joint dislocation,and 2 patients had symptoms of ulnar nerve. Mason classification of radial head fractures:2 cases were type Ⅰ,5 were type Ⅱ,4 were type Ⅲ. Classification of the coronoid process:Regan &Morrey:1 was type Ⅰ,10 were type Ⅱ;according to O’Driscoll classification,all the fractures were tip fracture,one was the first subtype,10 were the second subtype.The elbow were released,the coronoid process were fixed by lasso suture combined with Kirschner wires.Radial head fractures were resected in 1 case,and replaced in 1 case,3 cases with no treatment,6 cases with osteotomy and 3.0 mm headless compression screw (HCS)fixation.The lateral collateral ligament complex and the common extensor tendon were repaired to the humeral lateral epicon-dyles,No.2 Ethibon was used in 2 cases through bone holes,and suture anchorsin the other 9 cases.All the patients were fixed by Stryker DJDⅡhinged external fixator to protect the bone and soft tissue.Re-sults:The average follow-up time was (38.36 ±21.92)months (19-77 months).All the patients had no obvious pain,instability and ulnar nerve symptoms in the last follow-up.The average elbow flexion was 134.09°±12.41°(100°-140°),average extension was -15.91°±14.46°(-40°-0°),range of flexion and extension was 118.18°±23.80°(70°-140°).Average pronation was 70.91°±26.63° (20°-90°),supination was 70.91°±26.63°(20°-100°).The range of motion (ROM)of forearm rotation was 150.91°±43.00°(40°-180°).Average Mayo elbow performance score (MEPS)was 96.36 ±5.04 (85 -100).X-ray showed that no degenerative changes.Five patients had heterotopic os-sifications,according to Hastings and Graham grading:1 case was grade Ⅰ,3 cases were grade ⅡA, 1 case was ⅡB.Conclusion:The old “terrible triad”of elbow with no operative history is difficult to treat.The elbow’s functions and stabilization can be recovered by thorough elbow release,repair of coro-noid process and anterior capsule,radial head fractures,lateral collateral ligament and the common ex-tensor tendon insertion,combined with hinged external fixator.Joint stiffness and heterotopic ossification are common complications.

AN ANTERIOR NEUROVASCULAR INTERVAL APPROACH FOR FIXATION OF ULNA CORONOID PROCESS FRACTURE / 中国修复重建外科杂志

OBJECTIVE: To investigate the advantages and effectiveness of anterior neurovascular interval approach for fixation of ulna coronoid process fracture. METHODS: Between February 2011 and April 2015, 8 patients with ulna coronoid process fracture were treated with open reduction and internal fixation by anterior neurovascular interval approach. There were 5 males and 3 females, aged from 14 to 62 years (mean, 34 years). Fractures were caused by falling in 5 cases, traffic accident in 2 cases, and crashing in 1 case. The time between injury and operation was 1-6 days (mean, 3.5 days). According to Adams classification, there were 4 cases of type II, 1 case of type III, 2 cases of type IV, and 1 case of type V. In 1 patient with joint instability, lateral collateral ligament repair was given through another incision after fixation of coroniod fracture and the hinged external fixator, and plast splin was used to fix in the other patients; function exercise was done after removal of external fixtion. RESULTS: All incisions healed by first intention, and no complications of neurovascular injury and deep infection occurred. All patients were followed up 6-48 months (mean, 22 months). The healing time of fracture was 8-15 weeks (mean, 12.6 weeks). Mild myositis ossificans occurred in 1 case. The flexionextension arc of the elbow was (125.00±7.07)° and the forearm rotation was (135.00±7.07)°, showing no significant difference when compared with those of normal side[(126.88±7.53)° and (139.38±8.21)°] (t=0.469, P=0.654; t=2.198, P=0.054). According to Morrey's scale, the results were excellent in 6 cases, good in 2 cases; the excellent and good rate was 100%. CONCLUSIONS: Anterior neurovascular interval approach for reduction and internal fixation of ulna coroniod fractures has the advantages of simple operation, less trauma, and larger operative field. It can be used alone or combined with other surgical approaches.

Surgical Outcomes after Olecranon Plating with Retrograde Coronoid Process Screw Fixation through the Plate Hole in the Bifocal Fracture of the Proximal Ulna / 대한정형외과학회잡지

PURPOSE: Bifocal fracture of the proximal ulna is a fracture of the olecranon accompanied by fracture of the coronoid process. The purpose of the current study was to analyze the clinical results of the author's technique in bifocal fracture of the proximal ulna. MATERIALS AND METHODS: Fifteen patients (10 men, 5 women) treated at CHA Bundang Medical Center from April 2006 to October 2014 were analyzed retrospectively. All patients underwent internal fixation using a locking compression plate (LCP) with retrograde screw fixation of the coronoid process through a screw hole of the plate. Mean age of the patients was 42.6 years and the mean follow-up period was 18.6 months. Comminuted coronoid fractures with hard to screw fixation, complex injuries combined with open damage, and complete ligament rupture were excluded. Fracture union and articular congruity were examined on the follow-up radiographs. Range of motion, disability of the arm, shoulder and hand (DASH) score, and Mayo elbow performance score were evaluated for functional analysis. RESULTS: Fracture union was achieved and articular step off was less than 2 mm in all patients on the follow-up radiographs. The mean value of modified Mayo elbow score was 92.14 (80–100) and DASH score was 7.11 at last follow-up. The mean range of motion of elbow was 128o. There was one case of small heterotopic ossification as a radiographic complication which had no functional deficit. CONCLUSION: Internal fixation of bifocal multifragmentary articular fractures of the proximal ulna with anatomically contoured LCP olecranon plate and retrograde long screws could be a recommendable surgical procedure. This study showed that the precontoured plate with retrograde coronoid process screw fixation can produce good clinical and radiographic outcomes in bifocal fractures of the proximal ulna. We recommend this procedure in this type of fracture.

Bilateral elongated mandibular coronoid process in an Anatolian skull / 대한해부학회지

Elongation or hyperplasia of coronoid process of mandible is rare condition characterized by abnormal bone development which cause malocclusion and the limited mouth opening. In this study, in an Anatolian skull, a case of bilateral elongation of mandibular coronoid process was presented. Levandoski panographic analysis was performed on the panoramic radiographie to determine the hyperplasia of the coronoid process. The right condylar process was exactly hyperplastic. The measurements of Kr-Go/Cd-Go were 95.10 mm/79.03 mm on right side and 97.53 mm/87.80 mm on left side. The ratio of Kr-Go/Cd-Go on the right side was 1.20. Elongated coronoid process is one of the factors cause mandibular hypomobility, it as reported here might lead to limited mouth opening. The knowledge of this variation or abnormality can be useful for the radiologist and surgeons and prevent misdiagnosis.

Progress on diagnosis and treatment of the terrible triad of elbow joint / 中国骨伤

The terrible triad of elbow is a kind of complex elbow fracture dislocation, after reduction, it should get a concentric circles joint reduction and elbow stability, if radial and coronoid process fractures is less piece, the conservative treatment can be performed, but regularly follow up is mandatory. If surgical treatment was chosen, radial head fractures and the lateral collateral ligament complex must be repaired. Single lateral approach can be used and also can be combined with anteromedial approach in surgery. Some problems are still controversial in the treatment of coronoid process fracture with Morry type I and type II, such as fixation or not, whether additional external fixation and repair of the medial collateral ligament injury at the same time.

Post-traumatic-Zygomaticocoronoid Ankylosis: A Rare Clinical Case Report.

Fusion of the zygomatic bone to the coronoid process of the mandible is a rare phenomenon reported in the literature and commonly called as zygomaticocoronoid ankylosis. It can be sequel of trauma or infection in the midfacial region, mimicking a wide range of problems including the common temporomandibular joint ankylosis and dysfunction. Maxillofacial trauma involving the displaced fracture of zygoma can obstruct the movement of coronoid and if not treated can cause ankylosis between both bones. It is very diffi cult to identify zygomaticocoronoid ankylosis on conventional radiographs and requires the through clinical and advanced radiological evaluation like cone-beam computed tomographic (CBCT) to diagnose it. CBCT can be a great help to identify the size and extension of ankylotic mass and decide the approach to remove it. Zygomaticocoronoid ankylosis can be approached intraorally by Keen’s incision, and extraorally through a hemicoronal approach we have approached intraorally. Here, we present surgical management of post-traumatic zygomaticocoronoid ankylosis in 42-year-old male patient who had trismus for 18 years.

Variation in the Shape of Coronoid Process in Dry Mandible of Maharashtra Population.

Background: Knowledge about themorphological shapes of the coronoid process is useful for themaxillofacial surgeon. The Coronoid process can be easily harvested as a donor bone. It is also helpful in determining buccal vestibule during denture fabrication. Aim of the study: To find out the variation in shape of coronoid process and the intercoronoid distance in dry mandible of Maharashtra region. Material and Methods: One hundred and fifty seven (male 84 and female 73) dry mandible of Maharashtra region were studied for variations of shape in coronoid process of both sides and the intercoronoid distance . Results: Triangular shape coronoid process was found in 204 (64.97%), Hook shape in 66 (21.02%) sides. and rounded in 44 (14.01%) sides of mandible. Mean intercoronoid distance among males was found to be 9.2000 and 9.100 in females. Conclusions: It was found that most common shape of coronoid process found in our study was triangular. Mandible with hook shape coronoid process was almost equal in male and female mandible while triangular shape was slightly more in the male .

Effective evaluation of autogenous coronoid process reengineering condylar arthroplasty with simultaneous genioplasty / 重庆医学

Objective To evaluate the clinical effects of autogenous coronoid process reengineering condylar arthroplasty with simultaneous genioplasty for the correction of temporomandibular joint(TMJ)ankylosis accompanying micrognathia.Methods 21 cases of TMJ ankylosis with micrognathia from July 2003 to January 2012 were treated by autogenous coronoid process re-engineering condylar arthroplasty with simultaneous genioplasty.The follow-up period was 24 months to 8 years.TMJ function, mouth opening,occlusion,facial contour and the imaging manifestations were evaluated.Results After observation of follow-up,19 cases were improved obviously in the mandibular movement and mouth opening.Two cases had the recurrence of TMJ ankylosis. The facial appearance in all cases was significantly improved compared with before operation and the occlusal relationship had no large change compared with before operation.The coracoid process and mandibular ramus reached bone union with good reconstruc-tion by the panoramic radiographs.Compared with preoperation;the cephalometric results showed that the facial contour and process had statistical differences between postoperation and preoperation(P <0.05).Conclusion Autogenous coronoid process re-engineering condylar arthroplasty with simultaneous genioplasty can treat TMJ ankylosis accompanying micrognathia.