What is the treatment for a non-displaced Coronoid process fracture?

Treatment of Non-Displaced Coronoid Process Fractures

Non-displaced coronoid process fractures should be managed conservatively with posterior splint immobilization for 3-4 weeks, combined with early pain control and regular radiographic monitoring to ensure the fracture remains stable. 1

Initial Immobilization Strategy

• Use a posterior splint (back-slab) rather than a collar and cuff for immobilization, as this provides superior pain relief during the critical first 2 weeks after injury 1
• Immobilize the elbow for 3-4 weeks until clinical healing is evident 2
• The splint should provide adequate stability while allowing for appropriate healing 2

Pain Management Protocol

• Initiate simple analgesics such as paracetamol on a regular basis as first-line therapy unless contraindicated 2
• Use opioids cautiously, particularly in patients with potential renal dysfunction 2
• Non-steroidal anti-inflammatory drugs should be used with caution as they are relatively contraindicated in many patients 2

Radiographic Surveillance

Perform regular radiographic evaluation during the first 3 weeks of treatment and at the cessation of immobilization to confirm the fracture remains non-displaced 1. This is critical because:

• Coronoid fractures are sequelae of elbow trauma and commonly associated with soft tissue injuries that could lead to instability 3
• Early detection of displacement allows for timely intervention if conservative management fails 4

Important Clinical Considerations

When Conservative Treatment May Fail

• Monitor for progressive trismus or restricted mouth opening, which may develop even with initially appropriate conservative management 5
• If significant restriction develops (typically defined as limited mouth opening), surgical intervention may become necessary 5
• Approximately 25% of conservatively managed cases may develop progressive symptoms requiring later surgical intervention 5

Associated Injuries to Assess

Always evaluate for concomitant injuries including:

• Elbow dislocation (coronoid fractures are typically associated with prior dislocation) 3
• Ligamentous injuries, particularly the ulnar collateral ligament 4
• Zygomatic, zygomatic arch, or mandibular ramus fractures 5

The presence of these associated injuries may alter the treatment algorithm toward surgical management 5, 4

Indications for Surgical Intervention

While non-displaced fractures are managed conservatively, surgical fixation becomes necessary if:

• Fracture displacement progresses beyond 1 cm during follow-up 6
• Significant restriction of mouth opening develops despite conservative treatment 5
• Concomitant fractures of the zygoma, zygomatic arch, or mandibular ramus are present 5
• Elbow instability develops, indicating disruption of stabilizing structures 4

Follow-Up Protocol

• Patients should return for re-evaluation if symptoms worsen or do not improve as expected 2
• Continue monitoring until complete clinical and radiographic healing is confirmed 1
• Assess for late complications including traumatic osteoarthritis or heterotopic ossification, particularly if the fracture was associated with elbow instability 4