From the Guidelines
For a minimally displaced right elbow coronoid fracture in an 18-year-old female, simple immobilization is the most appropriate treatment approach. This recommendation is based on the principle that minimally displaced fractures, especially those that are nonarticular or have small fracture fragments, can be effectively managed without surgical intervention 1. The initial management should include a posterior splint with the elbow flexed at 90 degrees for 1-2 weeks, followed by a hinged elbow brace for an additional 2-4 weeks.
- Pain management should consist of acetaminophen 650mg every 6 hours and ibuprofen 400-600mg every 6-8 hours as needed, with the option of tramadol 50mg every 6 hours for breakthrough pain.
- Ice should be applied for 15-20 minutes every 2-3 hours during the first 48-72 hours to reduce swelling.
- After the initial immobilization period, a progressive rehabilitation program should begin, starting with gentle active range of motion exercises and gradually advancing to strengthening exercises over 6-12 weeks.
- Follow-up radiographs should be obtained at 1-2 weeks and 6 weeks to ensure proper healing, as confirmed by radiographic studies 1. This conservative approach prioritizes minimizing morbidity and promoting quality of life by avoiding the risks associated with surgical intervention, while also considering the low risk of complications and good bone quality in a young patient.
From the Research
Treatment Options for Minimally Displaced Coronoid Fracture
- For a minimally displaced coronoid fracture in an 18-year-old female, treatment options may include non-surgical management, as studies have shown that conservative treatment can provide good clinical results in the majority of patients 2.
- The decision to treat non-surgically depends on the size and location of the fracture, as well as the stability of the elbow joint. If the elbow is concentrically located on computed tomography and the patient can avoid varus stress for a month, non-operative treatment may be considered 3.
- A study published in the Journal of Shoulder and Elbow Surgery found that most coronoid fractures and fracture-dislocations with no radial head involvement can be treated non-surgically with elbow immobilization, with excellent or good results in more than 90% of cases 2.
- Another study published in the Archives of Orthopaedic and Trauma Surgery reported excellent outcomes in three patients with anteromedial coronoid fractures who were managed conservatively, suggesting that conservative treatment may be an option for selective cases with minimally displaced fractures and no evidence of elbow subluxation 4.
Key Considerations for Treatment
- The size and location of the fracture, as well as the stability of the elbow joint, are important factors to consider when determining the best course of treatment 3, 5.
- The presence of associated injuries, such as radial head fractures or ligamentous injuries, may also impact treatment decisions 3, 6.
- Regular follow-up and monitoring of the patient's condition are crucial to ensure proper healing and to address any potential complications that may arise 2, 4.