Tuesday, July 16, 2024

Innovative Minimally Invasive Technique Shows Promise for Coronoid Process Fracture Treatment

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In a groundbreaking study, researchers have introduced a highly extensile minimally invasive approach for treating coronoid process fractures, promising significant improvements in patient outcomes. By employing a mini-plate for anatomical reduction, stable fixation, and anterior capsular repair, this technique addresses the lack of consensus on the optimal fixation method for such fractures.

Methodology and Patient Assessment

The study analyzed 31 patients diagnosed with coronoid fractures accompanied by the “terrible triad” or posteromedial rotational instability, treated between April 2012 and October 2018. Using an anterior minimally invasive approach, anatomical reduction and mini-plate fixation were performed. Patient outcomes were assessed through the Mayo Elbow Performance Index (MEPI), range of motion (ROM), and visual analog score (VAS). The time to fracture healing and complication rates were meticulously recorded.

Results and Clinical Implications

The findings revealed a mean follow-up time of 26.7 months, with an average radiological union time of 3.6 ± 1.3 months. Throughout the follow-up, patients exhibited an average elbow extension of 6.8 ± 2.9° and flexion of 129.6 ± 4.6°, with 81% achieving a normal desired ROM according to Morrey’s criteria. The mean MEPI score at the last follow-up was 98 ± 3.3 points, indicating high functional recovery without instances of instability, stiffness, subluxation, dislocation, infection, or nerve palsy. However, 31% of elbows experienced heterotopic ossification.

The introduction of this minimally invasive technique could potentially enhance market access for advanced orthopedic treatments by demonstrating reduced complication rates and improved functional outcomes. Healthcare providers might find this approach appealing due to its effectiveness and potential for quicker patient rehabilitation, addressing a critical need in fracture management.

Key Inferences

The research highlights several valuable points for further consideration:

  • Minimally invasive techniques can offer significant benefits in terms of reduced soft tissue complications.
  • Stable fixation achieved through mini-plate application contributes to superior patient-reported outcomes.
  • Rapid return to rehabilitation exercises can be facilitated, potentially reducing overall treatment costs.
  • Enhanced market access for such innovative techniques may drive advancements in orthopedic care and patient satisfaction.

In conclusion, the anterior minimally invasive approach provides a reliable method for fixing coronoid fractures, ensuring satisfactory anatomical reduction and stable fixation while minimizing incision-related complications. This technique not only preserves the soft tissue integrity of the elbow joint but also promotes a swifter return to rehabilitation, marking a significant step forward in orthopedic surgical practices.

Original Article:

BMC Musculoskelet Disord. 2024 Jul 5;25(1):522. doi: 10.1186/s12891-024-07637-1.


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BACKGROUND: For the treatment of coronoid process fractures, medial, lateral, anterior, anteromedial, and posterior approaches have been increasingly reported; however, there is no general consensus on the method of fixation of coronal fractures. Here, we present a highly-extensile minimally invasive approach to treat coronoid process fractures using a mini-plate that can achieve anatomic reduction, stable fixation, and anterior capsular repair. Further, the study aimed to determine the complication rate of the anterior minimally invasive approach and to evaluate functional and clinical patient-reported outcomes during follow-up.

METHODS: Thirty-one patients diagnosed with coronoid fractures accompanied with a “terrible triad” or posteromedial rotational instability between April 2012 and October 2018 were included in the analysis. Anatomical reduction and mini-plate fixation of coronoid fractures were performed using an anterior minimally invasive approach. Patient-reported outcomes were evaluated using the Mayo Elbow Performance Index (MEPI) score, range of motion (ROM), and the visual analog score (VAS). The time of fracture healing and complications were recorded.

RESULTS: The mean follow-up time was 26.7 months (range, 14-60 months). The average time to radiological union was 3.6 ± 1.3 months. During the follow-up period, the average elbow extension was 6.8 ± 2.9° while the average flexion was 129.6 ± 4.6°. According to Morrey’s criteria, 26 (81%) elbows achieved a normal desired ROM. At the last follow-up, the mean MEPI score was 98 ± 3.3 points. There were no instances of elbow instability, elbow joint stiffness, subluxation or dislocation, infection, blood vessel complications, or nerve palsy. Overall, 10 elbows (31%) experienced heterotopic ossification.

CONCLUSION: An anterior minimally invasive approach allows satisfactory fixation of coronoid fractures while reducing incision complications due to over-dissection of soft tissue injuries. In addition, this incision does not compromise the soft tissue stability of the elbow joint and allows the patient a more rapid return to rehabilitation exercises.

PMID:38970051 | DOI:10.1186/s12891-024-07637-1

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