Usability of Minimal Invasive Surgery for Elbow Dislocation with Coronoid Process Fracture: A Protocol Development Study

Abstract

Objective: The study aims to explain whether or not minimal invasive surgery (MIS) would be feasible in elbow fracture–dislocation with coronoid process fracture. Methods: At Taipei Veterans General Hospital, patients who had elbow dislocations with coronoid process fractures underwent a single surgeon’s MIS techniques which included the fluoroscopy-guided ulnar anteromedial (FGUAM) approach in the stage of reducing the coronoid process. When there is a proximal ulnar fracture, the posterior incision should be necessary, followed by the incision over the lateral or medial elbow for treating radial fractures or ligament injuries. Results: The Flow Diagram for approach recommendation was established on the basis of defining MIS as that which does not include cross-plane dissection. The importance of anterior rigid fixation for the coronoid process was also emphasized. Conclusions: MIS can be achieved by multiple limited surgical incisions. Although the posterior extensile approach is necessary in situations of ulnar metaphysis or ligament avulsion fracture, the FGUAM approach decreases the cross-plane dissection.

Keywords

• minimal invasive surgery (MIS)
• coronoid process fracture
• elbow terrible triad
• posteromedial instability
• trans-olecranon
• trans-ulnar basal coronoid fracture–dislocation