title: Coronoid reconstruction with an osteochondral radial head graft.
abstract: BACKGROUND
  Chronic coronoid deficiency can occur subsequent to coronoid fracture malunion/nonunion or to coronoid hypoplasia or dysplasia resulting from injury during development. Several surgical options have been described to treat this difficult condition, but results are equivocal. We hypothesized that a modified coronoid reconstruction using a radial head osteochondral graft could restore elbow stability and congruity and that a technique involving rigid internal fixation would promote graft union.
  
  
  METHODS
  The coronoid was reconstructed using an osteochondral fragment from a frozen allograft radial head in 3 young women affected by complex post-traumatic elbow instability and incongruity resulting from coronoid deficiency. To promote bone healing, the fragment was kept as large as could be fitted in place, the cut surface compressed onto the remaining coronoid was as large as possible, the medial portion of the radial head (containing dense bone) was used, and 3 lag screws were inserted in different directions.
  
  
  RESULTS
  At a mean follow-up of 26 months, all 3 patients achieved a painless, congruent stable joint with a functional range of motion. Computed tomography scans performed 3 months after surgery showed complete union of the graft in all the patients. Each patient rated herself as "almost normal" or "greatly improved" on the Summary Outcome Determination scale.
  
  
  CONCLUSIONS
  Coronoid reconstruction with a radial head osteochondral allograft was successful in restoring stability and function in chronically unstable elbows with coronoid deficiency. Strong fixation using a large segment of the medial radial head achieved rapid graft healing.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedics and Traumatology, University of Turin Medical School, Turin, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Bellato
authors.affiliation: Shoulder and Elbow Surgery Unit, Rizzoli Orthopedic Institute, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rotini
authors.affiliation: Shoulder and Elbow Surgery Unit, Rizzoli Orthopedic Institute, Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marinelli
authors.affiliation: Shoulder and Elbow Surgery Unit, Rizzoli Orthopedic Institute, Bologna, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Guerra
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: odriscoll.shawn@mayo.edu.
authors.forename: Shawn W
authors.initials: SW
authors.lastname: O'Driscoll
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D001863:Bone Screws; D002356:Cartilage / Q000637:transplantation*; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D011884:Radius / Q000637:transplantation*; D016059:Range of Motion, Articular; D014457:Ulna / Q000601:surgery*; D055815:Young Adult
keywords: Coronoid deficiency; coronoid reconstruction; graft union; osteochondral graft; posttraumatic elbow incongruity; posttraumatic elbow instability; radial head