title: Selected anteromedial coronoid fractures can be treated nonoperatively.
abstract: BACKGROUND
  Surgical fixation is currently recommended for unstable anteromedial coronoid fractures, but the role of nonoperative management is not well defined. Our purpose was to report the functional and radiographic outcomes of select patients managed nonoperatively.
  
  
  METHODS
  Between 2006 and 2012, 10 patients with anteromedial coronoid fractures underwent nonoperative treatment. Outcomes assessed included elbow range of motion (ROM), stability, strength, radiographs, and 3 functional questionnaires, including the Patient-Rated Elbow Evaluation, Disabilities of Arm, Shoulder and Hand, and Mayo Elbow Performance Index.
  
  
  RESULTS
  There were 9 anteromedial subtype 2 coronoid fractures and 1 subtype 3. Mean fragment size was 5 mm, with a mean displacement of 3 mm for the subtype 2 fractures. The subtype 3 fracture was 9 mm in size with 1 mm of maximal gap displacement. At a mean follow-up of 50 months (range, 12-83 months), the average ROM of the affected elbow was 137° ± 8° of flexion, 2° ± 5° of extension, 88° ± 5° of pronation, and 86° ± 10° of supination. The mean Patient-Rated Elbow Evaluation score was 9 ± 13, Mayo Elbow Performance Index score was 94 ± 8, and the Disabilities of Arm, Shoulder and Hand score was 7 ± 9. All patients had bony union without radiographic arthrosis. There were no cases of recurrent instability or delayed surgical intervention.
  
  
  CONCLUSIONS
  Current indications for nonoperative management, based on the results of this study, include fractures that are small, minimally displaced, and most importantly, demonstrate no evidence of elbow subluxation. The elbow joint must be congruent and demonstrate a stable ROM to a minimum of 30° of extension. For selected anteromedial coronoid fractures, nonoperative management is an option that can lead to good clinical and radiographic outcomes.
authors.affiliation: Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Chan
authors.affiliation: Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Faber
authors.affiliation: Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada.
authors.forename: Graham J W
authors.initials: GJ
authors.lastname: King
authors.affiliation: Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada. Electronic address: gathwal@uwo.ca.
authors.forename: George S
authors.initials: GS
authors.lastname: Athwal
mesh_terms: D000328:Adult; D000070628:Closed Fracture Reduction; D004551:Elbow Joint; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011403:Pronation; D011859:Radiography; D016059:Range of Motion, Articular; D013484:Supination; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*
keywords: anteromedial coronoid; coronoid; elbow; fracture; instability; varus posteromedial instability