You are here

Coronoid Fracture S52.043A 813.02

Coronoid fracture xray

proximal ulna anatomy


Elbow Cross Sectional Anatomy

Type I Coronoid Fracture

Type II Coronoid Fracture

Type III Coronoid Fracture

Anteromedial Facet Coronoid Fracture

Posteromedial approach to the elbow

Type III coronoid fracture orif

synonyms: coronoid fracture, elbow fracture-dislocation


Coronoid Fracture ICD-10


Coronoid Fracture ICD-9

  • 813.02(closed fracture of coronoid process of ulna)
  • 813.12(open fracture of coronoid process of ulna)

Coronoid Fracture Etiology / Epidemiology / Natural History

  • Occur in 2-10% of elbow dislocations

Coronoid Fracture Anatomy

Coronoid Fracture Clinical Evaluation

  • Evaluate for tenderness or bruising at the radial and ulnar collateral ligament origins.
  • Evaluate for elbow stability.
  • Document NV exam.
  • Document wrist evaluation.

Coronoid Fracture Xray / Diagnositc Tests

  • A/P, lateral and oblique elbow films indicated. Coronoid fractures are often obscurbed by associated radial head fracture. "River delta sign"=narrowing of the joint space from lateral to medial=indicates coronoid fx or ligamentous instability.
  • Consider stress xrays to determine ligamentous stability. If any concern for instability is present stress radiographs are indicated. Stress xray comparisons to uninjured side are always helpful.
  • CT is best for determining fracture location and comminution and should be considered if the diagnosis is questionable, especially if associated with radial head fracture.

Coronoid Fracture Classification / Treatment

  • Reagan and Morrey (JBJS 71A:1348, 1989) classification based on review of 35 patients. Anteromedial Facet fractures later described by O'Driscoll.
  • Type I, stable (avulsion of the tip of the coronoid process): usually related to posterolateral rotatory elbow subluxation. Treatment = early protected ROM.
  • Type I, unstable or associated radial head fracture. Treatment = ORIF; if fragment is large enough for fixation with a screw or k-wire it should be fixed via the lateral exposure to the radial head. Any collateral ligament injury must be repaired as well.
  • Type II, stable( <50% of coronoid): Treatment = early protected ROM.
  • Type II, unstable or associated radial head fracture. Treatment = ORIF; if fragment is large enough for fixation with a screw or k-wire it should be fixed. Any collateral ligament injury must be repaired as well.
  • Type III (basal coronoid fracture): Treatment = ORIF usually via a posteromedial aproach. Often associated with olecranon fracture/dislocations. Associated injuries should be anatomically repaired as well.
  • Anteromedial Facet Fracture, stable: Occur with varus posteromedial rotation during axial loading. Associated with LCL rupture and are usually unstable. Treatment = ensure joint is stable with stress radiographs, consider EUA. Early protected ROM if joint is confirmed to be stable.
  • Anteromedial facet fracture, unstable: Treatment = ORIF with concomitant LCL/radial head repair usually via a utilitarian posterior exposure with posteromedial coronoid exposure. (Doornberg JN, JBJS 2006;88A:2216).
  • Always consider hinged external fixation for severe injuries where joint stability is a concern post-operatively.

Coronoid Fracture ORIF Technique

  • Note: Coronoid fractures can be fixed via a posteromedial exposure, or from a posterolateral exposure during radial head repair. A utilitarian posterior incision is general used.
  • Pre-operative antibiotics
  • Supine with arm board, tourniquet high on arm, C-arm available
  • Posterior incision from 6cm proximal to olecranon to 6cm distal to olecranon. Curved around medial border of olecranon to avoid painful scar.
  • Medial and lateral skin flaps are raised depending on associated pathology.
  • Ulnar nerve identified and transposed anterior to the medial epicondyle.
  • Flexor carpi ulnaris incised longitudinally, leaving a fascial cuff for later repair. FCU is subperiosteally elevated exposing anterior band of medial collateral ligament and the coronoid.
  • Fracture is repair using AO techniques with k-wires, screws and buttress plate as needed.
  • Irrigate.
  • FCU repaired.
  • Ulnar nerve secured anterior to the medial epicondyle with a fascial sling.
  • Close in layers.
  • Consider the use of a unilateral hinged external fixator placed on the lateral side to counteract varus gravitational stresses.

Coronoid Fracture Associated Injuries / Differential Diagnosis

Coronoid Fracture Complications

  • Instability
  • Stiffness, most will experience some loss of extention.
  • Arthritis
  • Infection
  • Heterotopic ossification

Coronoid Fracture Follow-up Care

  • Bulkly dressing with posterior splint post-operatively
  • 7-10 day post-operative: Splint removed, ROM in a hinged elbow brace is started with ROM determined by security of fixation achieved at surgery.
  • See also Elbow Outcome Measures.

Coronoid Fracture Review References


The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer