The contribution of the coronoid and radial head to the stability of the elbow

J Bone Joint Surg Br. 2012 Jan;94(1):86-92. doi: 10.1302/0301-620X.94B1.26530.

Abstract

We undertook this study to determine the minimum amount of coronoid necessary to stabilise an otherwise intact elbow joint. Regan-Morrey types II and III, plus medial and lateral oblique coronoid fractures, collectively termed type IV fractures, were simulated in nine fresh cadavers. An electromagnetic tracking system defined the three-dimensional stability of the ulna relative to the humerus. The coronoid surface area accounts for 59% of the anterior articulation. Alteration in valgus, internal and external rotation occurred only with a type III coronoid fracture, accounting for 68% of the coronoid and 40% of the entire articular surface. A type II fracture removed 42% of the coronoid articulation and 25% of the entire articular surface but was associated with valgus and external rotational changes only when the radial head was removed, thereby removing 67% of the articular surface. We conclude that all type III fractures, as defined here, are unstable, even with intact ligaments and a radial head. However, a type II deficiency is stable unless the radial head is removed. Our study suggests that isolated medial-oblique or lateral-oblique fractures, and even a type II fracture with intact ligaments and a functional radial head, can be clinically stable, which is consistent with clinical observation.

MeSH terms

  • Aged
  • Biomechanical Phenomena
  • Elbow Injuries*
  • Elbow Joint / physiopathology
  • Electromagnetic Phenomena
  • Female
  • Fractures, Bone / physiopathology*
  • Humans
  • Joint Instability / pathology
  • Joint Instability / physiopathology
  • Male
  • Middle Aged
  • Radius / surgery
  • Range of Motion, Articular / physiology