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A fracture of the radial head requiring ORIF
4%
152/3822
A highly comminuted radial head fracture requiring radial head arthroplasty or resection
5%
188/3822
An MCL injury requiring repair
10%
382/3822
A type I avulsion fracture of the coronoid
207/3822
An anteromedial coronoid fracture
74%
2842/3822
Select Answer to see Preferred Response
A varus and posteromedial rotation mechanism of injury typically results in a fracture of the anteromedial facet of the coronoid which frequently requires reduction and fixation to restore stability. A varus and posteromedial mechanism of injury about the elbow presents with an injury pattern distinctly different from other injury patterns. A key part of treating this injury pattern is recognizing a fracture of the anteromedial facet of the coronoid, which often requires reduction and fixation to restore stability about the elbow. It is important to recognize this during preoperative planning since this injury typically requires a medial approach. Steinman presents a review article describing coronoid fracture patterns and their mechanisms of injury. Doornberg and Ring present a level 4 review showing that coronoid fracture patterns and their required treatments are predictable based on mechanism of injury. Varus and posteromedial mechanisms were found to reliably create a fracture of the anteromedial facet of the coronoid, and were associated with sparing of the MCL and radial head. Doornberg and Ring also presented a Level 3 review of anteromedial facet cornoid fractures. They found that they could not be adequately visualized and treated from a lateral approach, and that they typically required reduction and fixation to restore adequate stability to the elbow. This stresses the importance of recognizing this injury pattern during preoperative planning. Illustrations A and B are AP and lateral radiographs of an elbow following a varus/posteromedial injury with an anteromedial coronoid facet fracture. Illustration C is a diagram demonstrating fracture lines that create an anteromedial facet fracture fragment. This fracture can be subclassified into three subtypes [anteromedial rim (a), rim plus tip (b), and rim and tip plus the sublime tubercle (c)] Incorrect answers: Answers 1, 2, 3: Radial head fractures, and MCL injuries are not seen in varus/posteromedial mechanisms. They are seen in terrible triad elbow injuries which are due to valgus and posterolateral rotatory forces. Answer 4: The coronoid fracture seen in these injuries is an anteromedial facet fracture, and not an avulsion fracture of the tip of the coronoid.
4.1
(8)
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