From the Guidelines
The treatment plan for a fracture of the coronoid process should prioritize conservative management, with surgery reserved for cases with significant displacement, instability, or large fragment involvement, as suggested by the most recent guidelines 1. When managing a coronoid process fracture, it is essential to consider the potential for associated soft tissue injuries, given that these fractures often occur as a sequela of prior elbow dislocation 1. The initial approach includes:
- Rest
- Ice
- Pain management with NSAIDs, such as ibuprofen (400-600mg every 6-8 hours) or naproxen (500mg twice daily)
- Immobilization with a sling or splint for 1-2 weeks Early range of motion exercises should be initiated after the acute pain subsides, typically within 7-10 days, to prevent stiffness.
- Physical therapy focusing on progressive elbow mobilization and strengthening is recommended for 4-6 weeks. Surgical intervention is considered for:
- Displaced fractures (>5mm displacement)
- Fractures with associated elbow instability
- When the fragment involves more than 50% of the coronoid Post-treatment follow-up should occur at 2 weeks, 6 weeks, and 3 months to assess healing and function. Most patients can expect good functional recovery within 3-4 months with appropriate management, balancing the need to protect the fracture while preventing complications from prolonged immobilization, as the coronoid process is crucial for elbow stability 1.
From the Research
Treatment Options for Fracture of the Coronoid Process
The treatment plan for a fracture of the coronoid process can vary depending on the location, displacement, and associated injuries.
- For fractures with minimal displacement or restriction of mouth opening, conservative management is often recommended 2, 3.
- However, for patients with significant fracture displacement, limited mouth opening, or concomitant fractures of the zygoma, zygomatic arch, or mandibular ramus, open reduction and internal fixation (ORIF) via the modified retromandibular approach may be considered 2, 3.
- Some studies suggest that ORIF can cause postoperative limited mouth opening and pain, and therefore conservative treatment may be more beneficial for patients 4.
Factors Influencing Treatment Decisions
The decision to opt for conservative management or surgical intervention depends on several factors, including:
- Degree of mouth opening
- Location of the coronoid fracture
- Types of fracture
- Presence of concomitant fractures
- Time of fracture
Comparison of Treatment Outcomes
Studies have shown that both conservative and surgical treatments can produce satisfactory outcomes, with significant improvement in maximum mouth opening and symptoms 2, 5.
- A systematic review of coracoid process fractures found that conservative treatment showed good results in most Ogawa type II fractures and type I fractures without associated disruptions of the SSSC, while surgical treatment may be considered in Ogawa type I fractures with multiple disruptions of the SSSC 5.