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Posteromedial rotatory instability with torn LUCL
33%
378/1153
Posteromedial rotatory instability with intact LUCL
37%
430/1153
Posterolateral rotatory instability with torn LUCL
21%
237/1153
Posterolateral rotatory instability with intact LUCL
5%
62/1153
Terrible triad of the elbow
3%
36/1153
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This patient an anteromedial coronoid facet fracture with posteromedial rotatory instability. His examination suggests an intact LUCL. Varus posteromedial rotatory instability occurs following a fall onto an outstretched hand with axial loading and an applied varus stress to the elbow. Varus posteromedial rotatory instability may occur secondary to a rupture of the posterior band of the medial collateral ligament (MCL), fracture of the anteromedial facet of the coronoid, and/or avulsion of the lateral ulnar collateral ligament (LUCL). With a positive lateral pivot shift test, a patient's LUCL is likely torn; in this setting, posterior splinting with the forearm in neutral is recommended. With an intact LUCL, a posterior splint is recommended with the forearm in full supination to tighten the structures medially. Ramirez et al. review varus posteromedial instability of the elbow as a result of traumatic injury to the medial facet of the coronoid and the lateral collateral ligament. They report that treatment of these fractures is usually surgical and consists of coronoid fracture fixation with plates, screws, or sutures and radial collateral ligament repair. They conclude that outcomes of these injuries are mixed, but most series report fair to good objective scores. Fedorka et al. reported that posterolateral rotatory instability of the elbow is often caused by a complex injury to the lateral ulnar collateral ligament complex. This often leads to chronic mechanical symptoms of instability and pain. Surgical repair or reconstruction of the ligament is often required to stabilize the radiocapitellar joint. Multiple techniques have been described in the literature for repair or reconstruction of the lateral ligamentous complex with overall good clinical outcomes. Incorrect Answers: Answer 1: While the presence of an anteromedial facet fracture of the coronoid suggests a positive posteromedial rotatory instability, this patient's examination finding of a negative lateral pivot shift test suggests an intact LUCL Answers 3&4: Posterolateral instability would be expected with a coronoid tip fracture, radial head fracture, and LCL injury Answer 5: A terrible triad injury of the elbow would reveal a coronoid fracture (transverse fracture pattern), radial head fracture, and elbow dislocation
4.3
(7)
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