Treatment of Non-Displaced Coronoid Process Fracture
Non-displaced coronoid process fractures should be treated conservatively with posterior splint immobilization, as these fractures do not compromise elbow stability and do not require surgical intervention.
Initial Management
Immobilization with a posterior splint is the treatment of choice for non-displaced coronoid fractures. 1 This approach provides:
- Adequate pain relief within the first 2 weeks after injury 1
- Sufficient stabilization while allowing appropriate fracture healing 1
- Rigid support without the complications associated with surgical intervention 1
The key principle is that non-displaced fractures maintain elbow stability, making operative treatment unnecessary. 2
Treatment Algorithm Based on Fracture Characteristics
Type I Fractures (Coronoid Tip, <50% Height)
- Conservative treatment is indicated unless the bone fragment mechanically blocks elbow motion 2
- These small fragments do not compromise elbow stability and heal well with immobilization 2
- Surgical intervention is only needed if the fragment causes mechanical symptoms 2
Critical Distinction: Displacement and Stability
The size and displacement of the coronoid fragment directly determines treatment approach:
- Non-displaced fractures maintain elbow stability and can be managed conservatively 3, 2
- Fractures involving >30% of the coronoid arc that are displaced cause instability and require surgical fixation 4
- If the elbow remains concentrically located on imaging, non-operative treatment is appropriate 3
Follow-Up Protocol
Regular radiographic monitoring is essential to detect any late displacement during the healing period. 1 This is a critical pitfall to avoid, as:
- Initially non-displaced fractures can lose position during healing
- Late displacement can lead to elbow instability and poor outcomes 5, 6
- Serial radiographs should be obtained at regular intervals during the immobilization period 1
Common Pitfalls to Avoid
Do not assume all coronoid fractures can be treated conservatively. The treatment decision hinges on:
- Elbow stability assessment - if the elbow subluxates or dislocates, surgical treatment is required regardless of fragment size 5, 6
- Associated injuries - coronoid fractures often occur with radial head fractures and ligament injuries that may require operative management 3
- Fragment size and location - anteromedial facet fractures and base fractures often require surgical fixation even when minimally displaced 5, 6
The critical error is failing to recognize associated instability patterns. Patients with varus stress or posteromedial rotational injury mechanisms may have unstable fracture patterns requiring surgical stabilization with plate fixation, even if the coronoid appears minimally displaced. 5, 6