Coronoid fractures occur in the ulna bone and can reduce elbow stability and movement. They are usually caused by falls and may require surgery. Treatment involves maintaining elbow stability and regaining range of motion, with physical therapy if necessary. Long-term complications include decreased range of motion, osteoarthritis, and paresthesia.
A coronoid fracture is a break in the coronoid process of the ulna, a small triangular piece of bone that projects outward from the top front of the ulna. The ulna is the inside of the two long bones located in the forearm, on the opposite side of the thumb. Coronoid fractures rarely occur without some sort of other ulnar fracture or elbow dislocation. Falls in which the arms are outstretched are the most common causes of coronoid fractures.
The coronoid process plays an important role in stabilizing the elbow. Several ligaments in the arm attach to the coronoid, including the brachialis, the muscle in the upper arm that allows the elbow to flex. The collateral ligaments and several flexor tendons are also attached to the coronoid process. A coronoid fracture can reduce elbow stability and make forearm movement difficult.
Symptoms of a coronoid fracture include pain and swelling in the elbow. Depending on the severity of the fracture, elbow flexion and extension may be difficult or impossible. In addition to an X-ray to determine the extent of the fracture, a complete neurovascular exam is needed to measure nerve function and blood flow to the area. A computed tomography scan, or CT scan, may be done to provide the treating doctor with more anatomical details regarding the fracture.
Treatment of a coronoid factor depends on the type and severity of the rupture. In cases where the fracture involves less than 50 percent of the coronoid process, the break can be treated without surgery. Early mobilization is typically preferred, with the patient regaining some mobility within the first month after the rupture to prevent stiffness.
Coronoid fractures involving more than 50% of the process typically require surgery to repair the damage internally. In some cases, part of the radial head or olecranon, an eminence of the body behind the elbow, can be used to reshape the coronoid process. The surgeon may use metal screws to stabilize the elbow and help the coronoid process heal.
After treatment of a coronoid fracture, follow-up focuses on both maintaining overall elbow stability and regaining range of motion. During each stage of recovery, X-rays are used to determine how well the treatment is working and whether the bone is healing properly. Physical therapy may be needed to help regain as much range of motion as possible.
Long-term complications include decreased range of motion, osteoarthritis, and ongoing pain. Paresthesia, a numbness, tingling, or tingling sensation in the skin, is also a possible long-term complication. Younger patients have a lower risk of complications than older patients.
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