title: Strategic approach to O'Driscoll type 2 anteromedial coronoid facet fracture.
abstract: BACKGROUND
  The purpose of this study was to suggest a strategic approach to the management of anteromedial coronoid facet (AMCF) fracture that is related to posteromedial rotational instability of the elbow through investigation of the surgical outcome of diverse combinations, including internal fixation of AMCF fractures and repair of collateral ligament injury.
  
  
  METHODS
  The study enrolled 18 patients. On the basis of the size of the coronoid fracture and the degree of the soft tissue injuries that were evaluated with computed tomography, magnetic resonance imaging, and varus stress test under anesthesia, these fractures were managed differently. Functional outcomes were evaluated with the visual analog scale score, modified Mayo Elbow Performance Score, and Disabilities of the Arm, Shoulder and Hand score. Plain radiographs were used to evaluate the degree of arthrosis.
  
  
  RESULTS
  There were 2 cases of O'Driscoll type 2, subtype 1 fractures; 14 cases of type 2, subtype 2 fractures; and 2 cases of type 2, subtype 3 fractures. Seven cases were managed with only AMCF fracture fixation, 4 cases with only lateral ulnar collateral ligament (LUCL) repair, 6 cases with concomitant repair of the LUCL and AMCF fracture, and 1 case with a conservative method. There were no significant differences among O'Driscoll types and among the subgroups of type 2-2 (P > .05). When the elbow showed instability on the varus stress test after AMCF fracture fixation, the soft tissue injuries of the lateral elbow were more severe (P =. 015). Arthrosis was not correlated with the patient's symptoms (P > .05).
  
  
  CONCLUSIONS
  AMCF fracture can be treated by only AMCF fracture fixation, only LUCL repair, or a combination of these techniques, depending on the size of the AMCF fracture fragment and the degree of the lateral soft tissue injuries.
authors.affiliation: Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeng Christianity Hospital, Pohang, Kyeongbuk, South Korea. Electronic address: osdrrih@gmail.com.
authors.forename: In Hyeok
authors.initials: IH
authors.lastname: Rhyou
authors.affiliation: Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeng Christianity Hospital, Pohang, Kyeongbuk, South Korea.
authors.forename: Kyung Chul
authors.initials: KC
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeng Christianity Hospital, Pohang, Kyeongbuk, South Korea.
authors.forename: Ji-Ho
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeng Christianity Hospital, Pohang, Kyeongbuk, South Korea.
authors.forename: Seung Yeon
authors.initials: SY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D017885:Collateral Ligaments / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D017695:Soft Tissue Injuries / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D014458:Ulna Fractures / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D000092464:Elbow Injuries
keywords: Anteromedial coronoid facet fracture; lateral ulnar collateral ligament; posteromedial rotatory instability