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Anterior interosseous nerve palsy
2%
76/3731
Varus posteromedial rotatory instability
62%
2301/3731
Posterior interosseous nerve palsy
3%
99/3731
Valgus posterolateral rotatory instability
24%
894/3731
Elbow instability when pushing oneself up from a seated position in a chair
9%
325/3731
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Anteromedial coronoid facet fracture and LCL injury following an elbow dislocation is commonly associated with varus posteromedial rotatory instability. Varus and posteromedial rotation force on the forearm results in rupture of the LCL from its humeral origin. As the LCL ruptures, the medial coronoid process is fractured as it impacts against and under the medial trochlea. Fracture involvement of the sublime tubercle, where the MCL attaches, can lead to more instability. Ulnar neuropathy can be seen following this injury pattern but AIN and PIN nerve palsy do not commonly characterize this injury pattern. The review article by O'Driscoll highlights key points in diagnosis and management of capitellum, distal humerus, coronoid, and terrible triad injuries. The article by Doornberg and Ring is a Level 4 study of 18 patients that sustained varus posteromedial rotational injuries resulting in anteromedial facet coronoid fractures. They found that lack of fixation at injury or malunion of the anteromedial facet were significant predictors of suboptimal functional outcome and development of arthrosis. The anteromedial facet is highlighted in yellow as displayed in Illustration A. Illustration B depicts the lateral collateral ligament injury also evident during varus stress fluroscopic examination, due to tension failure of the LCL off its humeral origin during the various mechanism.
3.6
(46)
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