Improvement of the Elbow Function with Early Mobilization and Rigid Fixation of Coronoid Fracture by Tension Band Technique

ABSTRACT

PURPOSE: We wanted to evaluate the surgical results of early mobilization after rigid fixation of small coronoid fracture using the tension band technique MATERIALS AND METHODS: Eight cases of coronoid fracture were fixed with the tension band technique and using K-wire and wire through the medial approach. All the cases were Regan-Morrey type 2. According to O'Driscoll, they were classified as 5 cases of the tip type (subtype 2) and 3 cases of the anteromedial type (1 case of subtype 2, and 2 case of subtype 3). The associated collateral ligament injuries (6 cases) and radial head/neck fractures (4 cases) were managed simultaneously. After immobilization for 5~7 days, active ROM exercise with a fitted hinge brace started and continued till postoperative 6 weeks. The patients were assessed for pain, ROM and functional disability using the Mayo elbow performance score (MEPS) at an average of 11 months (range 6~28 months). The ulnar nerve symptoms were also investigated. RESULTS: We observed solid union in all the coronoid fractures without hardware failure. An average of 2.2 wires (range 2~4) were used. The mean extension was 3degrees (range 0degrees~25degrees), the mean flexion was 137degrees (range 130degrees~140degrees), the mean pronation was 69degrees (range 45degrees~90degrees) and the mean supination was 78degrees (range 45degrees~90degrees). The mean MEPS was 96 (range 65~100). Ulnar nerve symptoms occurred at postoperative one day and persisted in one patient with the terrible triad of taking radial head excision and residual medial instability. CONCLUSION: The tension band technique uses easily obtained, economic K-wires and the wire was strong enough to permit early elbow ROM exercise and the technique might improve the elbow function. It was especially useful for fixation of multiple small fragments.