Surgical Outcomes and Complication Rates of Arthroscopic-assisted Fixation Versus Open Fixation for Coronoid Fractures: A Systematic Review and Meta-analysis

Overview

Journal Shoulder Elbow

Date 2024 Nov 18

PMID 39552669

Authors

Erica Kholinne

Hua Liu

Leonard Christianto Singjie

Maria Anastasia

Jae-Man Kwak

In-Ho Jeon

Affiliations

Soon will be listed here.

Abstract

Background: Coronoid fractures often occur with complex elbow dislocations, accounting for 15% of elbow fractures. The effectiveness of open reduction internal fixation (ORIF) versus arthroscopic-assisted reduction internal fixation (ARIF) surgeries for coronoid fractures remains uncertain. This study aimed to compare the outcomes of these two surgical approaches in treating varus posteromedial injuries.

Methods: This study was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study protocol was registered with PROSPERO. The primary outcomes assessed in this study were the functional outcomes measured by the Mayo Elbow Performance Score (MEPS) and the complications associated with each surgical approach.

Results: Analysis of the data from 759 patients included in this study revealed that the mean postoperative MEPS score was higher in the ARIF group compared to the ORIF group (97.5 Vs. 90.7), with the mean improvement in MEPS was 16.6 points (19 for ORIF and 14.3 for ARIF). The complication rate in the ORIF group was 24.6%, while the ARIF group reported a complication rate of 6%.

Conclusion: This study suggests that ARIF surgery can yield comparable and promising outcomes to ORIF surgery for coronoid fractures.

Level Of Evidence: IV.

References

Rausch V, Neugebauer S, Leschinger T, Muller L, Wegmann K, Hackl M . Injuries to the Coronoid Process of the Ulna with Involvement of the Lesser Sigmoid Notch. Z Orthop Unfall. 2020; 160(1):35-39. DOI: 10.1055/a-1263-1742. View

Kumar D, Sodavarapu P, Kumar K, Hooda A, Neradi D, Bachchal V . Functional Outcome of Surgically Treated Isolated Coronoid Fractures With Elbow Dislocation in Young and Active Patients. Cureus. 2020; 12(10):e10883. PMC: 7652368. DOI: 10.7759/cureus.10883. View

Budoff J, Meyers D, Ambrose C . The comparative stability of screw versus plate versus screw and plate coronoid fixation. J Hand Surg Am. 2011; 36(2):238-45. DOI: 10.1016/j.jhsa.2010.10.022. View

Dowdy P, Bain G, King G, Patterson S . The midline posterior elbow incision. An anatomical appraisal. J Bone Joint Surg Br. 1995; 77(5):696-9. View

Domos P, Ascione F, Wallace A . Arthroscopic Bankart repair with remplissage for non-engaging Hill-Sachs lesion in professional collision athletes. Shoulder Elbow. 2019; 11(1):17-25. PMC: 6348582. DOI: 10.1177/1758573217728414. View

Park S, Lee J, Jung J, Kim J, Song K . How should anteromedial coronoid facet fracture be managed? A surgical strategy based on O'Driscoll classification and ligament injury. J Shoulder Elbow Surg. 2014; 24(1):74-82. DOI: 10.1016/j.jse.2014.07.010. View

Wells J, Ablove R . Coronoid fractures of the elbow. Clin Med Res. 2008; 6(1):40-4. PMC: 2442031. DOI: 10.3121/cmr.2008.753. View

Rhyou I, Kim K, Lee J, Kim S . Strategic approach to O'Driscoll type 2 anteromedial coronoid facet fracture. J Shoulder Elbow Surg. 2014; 23(7):924-32. DOI: 10.1016/j.jse.2014.02.016. View

Feng D, Zhang X, Jiang Y, Zhu Y, Wang H, Wu S . Plate fixation through an anterior approach for coronoid process fractures: A retrospective case series and a literature review. Medicine (Baltimore). 2018; 97(36):e12041. PMC: 6133425. DOI: 10.1097/MD.0000000000012041. View

10.

Agarwal S, Loder S, Brownley C, Cholok D, Mangiavini L, Li J . Inhibition of Hif1α prevents both trauma-induced and genetic heterotopic ossification. Proc Natl Acad Sci U S A. 2016; 113(3):E338-47. PMC: 4725488. DOI: 10.1073/pnas.1515397113. View

11.

Choi C, Seok H, Park S . Arthroscopic Reduction and Fixation of Coronoid Fractures with Bending K-Wire: A New Technique. J Clin Med. 2022; 11(17). PMC: 9456358. DOI: 10.3390/jcm11174964. View

12.

McLean J, Kempston M, Pike J, Goetz T, Daneshvar P . Varus Posteromedial Rotatory Instability of the Elbow: Injury Pattern and Surgical Experience of 27 Acute Consecutive Surgical Patients. J Orthop Trauma. 2018; 32(12):e469-e474. DOI: 10.1097/BOT.0000000000001313. View

13.

Manidakis N, Sperelakis I, Hackney R, Kontakis G . Fractures of the ulnar coronoid process. Injury. 2011; 43(7):989-98. DOI: 10.1016/j.injury.2011.08.030. View

14.

Yan R, Wu Y, Xiang Z, Li S, Qi Y, Li H . A Novel Suture-Preset Spring Plate System (SSPS) for Comminuted Coronoid Process Fracture in the Elbow. Orthop Surg. 2022; 14(10):2580-2590. PMC: 9531073. DOI: 10.1111/os.13460. View

15.

Morellato J, Louati H, Desloges W, Papp S, Pollock J . Fixation of Anteromedial Coronoid Facet Fractures: A Biomechanical Evaluation of Plated Versus Screw Constructs. J Orthop Trauma. 2018; 32(11):e451-e456. DOI: 10.1097/BOT.0000000000001266. View

16.

Han S, Yoon H, Rhee S, Lee J . Anterior approach for fixation of isolated type III coronoid process fracture. Eur J Orthop Surg Traumatol. 2013; 23(4):395-405. DOI: 10.1007/s00590-012-1007-y. View

17.

Klug A, Buschbeck S, Gramlich Y, Buckup J, Hoffmann R, Schmidt-Horlohe K . Good outcome using anatomically pre-formed buttress plates for anteromedial facet fractures of the coronoid-a retrospective study of twenty-four patients. Int Orthop. 2019; 43(12):2817-2824. DOI: 10.1007/s00264-019-04354-6. View

18.

Thayer M, Swenson A, Hackett D, Hsu J . Classifications in Brief: Regan-Morrey Classification of Coronoid Fractures. Clin Orthop Relat Res. 2018; 476(7):1540-1543. PMC: 6437590. DOI: 10.1007/s11999.0000000000000072. View

18.

Chaabna K, Cheema S, Abraham A, Maisonneuve P, Lowenfels A, Mamtani R . The state of population health research performance in the Middle East and North Africa: a meta-research study. Syst Rev. 2021; 10(1):1. PMC: 7777412. DOI: 10.1186/s13643-020-01552-x. View

19.

Pugh D, Wild L, Schemitsch E, King G, McKee M . Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg Am. 2004; 86(6):1122-30. DOI: 10.2106/00004623-200406000-00002. View