Treatment Analysis Of Ulna Coronoid Process Fractures For 68 Cases

Objective:To analyse the treatment of fracture of ulna coronoid process and guiding significance of fracture classification by retrospective studies, and put forward the existing divergence and problems in the treatment of ulna coronoid process fractures at present.Methods:23 patients of ulna coronoid process fractures were treated between March 1998 and December 2008 in our hospital. There were 22 males and 1 female with an average age of 32.5 years old (range,11-61 years old).12 fractures occurred on the left elbow,11 on the right. The mechanism of injury was fall in 16 cases, traffic injury in 5 cases, wringer injury in 2 cases. 13 patients suffered isolated ulna coronoid fracture,10 patients suffered multiple fractures in ipsilateral elbow. According to Regan-Morrey fracture classification, There were 6 typeâ… ,8 typeâ…¡and 7 typeâ…¢. In addition there were 2 fracture of anteromedial facet of the coronoid process in this group which can not be classified with Regan-Morrey classification. There was no record of O'Driscoll facture classification in our cases. In this group, operative treatment were applied in 19 cases, resection of fragments in 4 cases, screws fixation in 9 cases, Kirschner wire fixation in 1 cases, screws and Kirschner wire fixation in 2 cases, plate fixation in 2 cases, Kirschner wire and silk suture fixation in 1 cases. Immobilization of the elbow with a long arm plaster splint or cast was applied in 4 cases because of other reasons.Result:In all the cases,18 were followed up for a average of 48 months (range, 8-103months),5 cases were lost. All the fractures heeled well, and the averaged union time was 12.4 weeks. The clinical results were evaluated according to Morrey's scale. In operative treatment group,6 cases were rated as excellent,6 as good,3 as fair and 0 as poor, the other 4 cases were lost, the excellent and good rate was 80%.In non-operative group, lcase as fair and 2 as poor,1 case was lost. There were 8 cases adopted the anterior median incision to expose the ulna coronoid process,5 of them got symptoms of median nerve injury after the operation.Conclusion:1. Compared to the coronoid process fractures with other parts fractures in ipsilateral elbow, the treatment effect of the isolated ulna coronoid fracture is better.2. The O'Driscoll fracture classification is more suitable for the treatment of traumatic fracture-dislocation of the elbow.3. Most of the ulna coronoid process fractures should be treated by operation. The injured soft-tissue and osseous structures must be repaired simultaneously.4. Treatment of the "terrible triad" should comply with the present treatment principle rigorously. 5. To prevent median nerve injury, the anterior median incision of elbow should be avoided when the ulna coronoid process is exposed.