Treatment of Ulnar Coronoid Process Fracture Using the Anterior Neurovascular Interval Approach: A Retrospective Clinical Study with Short‐ to Mid‐term Follow‐up

TL;DR

This study shows that a specific surgical approach for ulnar coronoid process fractures leads to good recovery and stable results in the short to mid-term.

Contribution

The study introduces and evaluates the anterior neurovascular interval approach for treating ulnar coronoid process fractures.

Findings

Patients showed significant improvement in elbow function and pain reduction after surgery.

All fractures healed, and elbow stability was satisfactory during follow-up.

The surgical approach allowed direct access to the fracture site for effective fixation.

Abstract

Numerous surgical techniques for addressing ulnar coronoid process fractures are available; however, a consensus on the optimal approach remains elusive. This study aimed to use the anterior neurovascular interval approach for the surgical management of ulnar coronoid process fractures and to evaluate its clinical outcomes over short‐ to mid‐term follow‐up.

This retrospective clinical study included 20 patients with ulnar coronoid process fractures who were treated using the anterior neurovascular interval approach between January 2018 and December 2022. Participants comprised 16 males and four females, aged between 20 and 64 years (mean, 34.3 ± 12.44 years). Clinical and radiological evaluations were based on elbow joint range of motion (ROM), Visual analogue scale (VAS), and Mayo elbow performance score (MEPS). A paired t‐test was used to compare the pre‐operative and final follow‐up VAS and MEPS scores.

The follow‐up duration for all patients was at least 12 months (average, 12.65 ± 1.60 months). At the final follow‐up, measurements of elbow ROM included a mean extension of 2.85 ± 3.17°, mean flexion of 135 ± 7.25°, mean pronation of 86.4 ± 4.56°, and mean supination of 84.85 ± 5.54°. All participants reached their target MEPS, with an average score of 97.25 ± 4.72 points, and the final mean VAS score was 0.2 ± 0.52 points. The VAS score was significantly lower and MEPS score was higher at the final follow‐up than those before surgery (p < 0.05). Throughout the follow‐up period, all the fractures united, and the stability of the affected elbows was satisfactory.

Employing the anterior neurovascular interval approach for open reduction and internal fixation to manage coronoid process fractures effectively facilitates anatomical restoration and robust fixation of ulnar coronoid process fractures.

The anterior neurovascular interval approach consists of dissecting loose tissue between the brachial artery and median nerve and pulling the brachial artery toward the radial side and the median nerve toward the ulnar side to reveal the brachialis. Subsequently, the brachialis was split along its fibers to expose the joint capsule. Once the joint capsule is incised, the surgeon gains direct access to the coronoid process fracture fragments and the joint surface for reduction and fixation.

Figures