Coronoid Process Fracture
Description/Cause
- Morrey Classification
- Type I: avulsion from the tip
- Type II: single or comminuted fragment involving 50% of the process or less
- Type III: single or comminuted fragment involving more than 50% of the process. This is suffixed with either an A or a B respectively with regard t absence or presence of an associated elbow dislocation
- O’Driscoll Classification
- Type 1: transverse fractures of the tip of the coronoid process and do not extend medially past the sublime tubercle or into the body
- Type 2: involve the anteromedial facet
- Type 3: basal (at least 50% of the height) coronoid fractures
- Causes
- Fall on an outstretched hand
- Fall directly onto the elbow
- Twisting with flexion
- Hyperextension
- Often occur during sports or any activity of daily living
Prevalence/Risk Factors
- Occur in 14% of all proximal ulna fractures
- 3/4 of all cases are associated with other injuries
- Isolated 27%
- Complex 73%
- Olecranon fracture 18%
- Proximal radial fracture no dislocation 27%
- Proximal radial fracture and elbow dislocation 18%
- Elbow dislocation 9%
Signs/Symptoms
- Pain
- Swelling
- Instability of the elbow joint
- Difficulty with movement at the elbow
Objective/Special Tests
- Radiographs
- MRI
- Palpation
- Range of motion
- MMT
- Valgus stress testing
Treatment/Interventions
- Dependent on the fracture type and associated injuries
- Morrey type I: rarely requires surgery
- Morrey type II: may require surgery
- Morrey type III: usually require surgical treatment
- Surgical
- Must determine which fragments need to be addressed before choosing a technique
- Non-surgical
- Bracing
- Immobilization post-surgery can lead to long-term loss of range of motion and function
- Rehabilitation
- Restore range of motion
- Early motion is difficult, but desired
- Restore stability
- Exercises for return to functional activities
1 Peach C, Ali A. Mini-symposium: the elbow: (iii) Proximal ulna fractures. Orthopaedics And Trauma [serial online]. October 1, 2012;26:310-315. Available from: ScienceDirect, Ipswich, MA. Accessed July 7, 2015.
2 Wang Y, Meng Q, Wu J, Ma J, Liu F. Treatment of fractures of the ulnar coronoid process. Orthopaedic Surgery [serial online]. November 2009;1(4):269-274. Available from: MEDLINE, Ipswich, MA. Accessed July 1, 2015.
Acknowledgements:
David Funk, Student Physical Therapist at A.T. Still University
Ethan Hunke, Student Physical Therapist at A.T. Still University
Morgan Johnson, Student Physical Therapist at A.T. Still University
Ed Nheiu, Student Physical Therapist at A.T. Still University
Lindsay Walczak, Student Physical Therapist at A.T. Still University
Last edited: July 13, 2015
David Funk, Student Physical Therapist at A.T. Still University
Ethan Hunke, Student Physical Therapist at A.T. Still University
Morgan Johnson, Student Physical Therapist at A.T. Still University
Ed Nheiu, Student Physical Therapist at A.T. Still University
Lindsay Walczak, Student Physical Therapist at A.T. Still University
Last edited: July 13, 2015