What is the treatment plan for a displaced coronoid process fracture?

From the Guidelines

The treatment plan for a displaced coronoid process fracture typically involves surgical intervention, with open reduction and internal fixation (ORIF) being the recommended approach to restore anatomical alignment and stability of the elbow joint. This is based on the understanding that injuries to the coronoid process are often a sequela of prior elbow dislocation, which is typically associated with soft tissue injury, as noted in the study by 1. The surgical approach depends on the fracture pattern, with anteromedial or lateral approaches commonly used. Fixation methods include screws, plates, or suture anchors based on fragment size and location.

Following surgery, the elbow is typically immobilized in a posterior splint at 90 degrees of flexion for 1-2 weeks. Early controlled range of motion exercises should begin after this initial period to prevent stiffness, with physical therapy focusing on gradually increasing motion and strength. Weight-bearing restrictions are usually maintained for 6-8 weeks. Pain management includes NSAIDs like ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily), with short-term opioids like hydrocodone/acetaminophen (5/325mg every 4-6 hours as needed) for breakthrough pain in the immediate post-operative period.

Key considerations in the treatment plan include:

• The importance of assessing for associated tendon injuries, as coronoid process fractures often occur in the context of elbow dislocation and soft tissue injury 1.
• The need for regular follow-up appointments with radiographs to monitor healing progress.
• The potential for elbow instability if the fracture is not properly reduced and fixed, given the coronoid process's role as an anterior buttress against posterior displacement of the ulna.

Overall, the goal of treatment is to restore functional stability to the elbow joint, minimize the risk of long-term complications such as arthritis or chronic instability, and optimize the patient's quality of life and functional outcomes.

From the Research

Treatment Plan for Displaced Coronoid Process Fracture

The treatment plan for a displaced coronoid process fracture can be categorized into two main approaches: conservative management and surgical management.

• Conservative management is recommended for fractures with minimal displacement or restriction of mouth opening 2, 3, 4.
• Surgical management, specifically open reduction and internal fixation (ORIF), is recommended for patients with significant fracture displacement, limited mouth opening, or concomitant fractures of the zygoma, zygomatic arch, or mandibular ramus 2, 3, 4.

Surgical Approaches

Different surgical approaches can be used to treat displaced coronoid process fractures, including:

• Modified retromandibular approach 2
• Anterior minimally invasive approach 5
• These approaches aim to achieve anatomic reduction, stable fixation, and repair of the anterior capsule.

Treatment Outcomes

Studies have reported significant improvement in maximum mouth opening and symptoms, such as diet and pain, after treatment 2, 3, 5.

• The choice of treatment modality depends on the severity of the fracture, the presence of concomitant fractures, and the patient's overall condition 2, 3, 4.