The Surgical Outcomes of the Coronoid Process Fractures of the Ulna Using the Novel “Hooked Kirschner Wire Technique”

摘要

Objective: The coronoid process, one of the main constraints providing ulnohumeral joint stability, provides a buttress against posterior displacement of the elbow joint. It is still a challenging problem even for an expert surgeon to fix this small fracture although many fixation methods are introduced and available. Aim: We want to introduce the novel method, “hooked Kirschner wire technique,” and report the clinical outcomes of these methods for the treatment of 24 patients with coronoid fractures with instability of the ulnohumeral joint. Methods: The average age was 46 years (range, 17-79). Twelve cases had initial dislocation of the elbow and 7 of them had radial head fractures (terrible triad). According to O’Driscoll’s classification, there were 3 tip types, 18 anteromedial types, and 3 base types. All cases were treated by the hooked K-wire technique and followed for an average of 12 months (range, 6-27) with outcomes evaluated using the Mayo Elbow Performance Scoring (MEPS) system. Results: One coronoid fracture was not healed and underwent second operation. The average active motion of the elbow joint was 126° (range, 78-160). The average score of MEPS was 96 (range, 80-100). There were 19 excellent and 5 good results. Conclusion: The hooked K-wire technique provided a stable fixation and a satisfactory union for displaced coronoid process fractures with the unstable elbow. This technique has some advantages. First, it is cheap and easy to handle. Second, the small fragment can be fixed medially or laterally. Last, it could be used as a temporary fixator for additional plating or screwing.