Reconstruction for persistent instability of the elbow after coronoid fracture-dislocation

The results of reconstruction for chronic instability after coronoid fracture have not been previously described. Patients with persistent instability after coronoid fracture-dislocation were assessed after reconstruction. A satisfactory outcome was considered to be present based on the Mayo Elbow Performance Score and on the patient’s willingness to repeat the operation. The length of follow-up was a minimum of 2 years, averaging over 5 years. Overall, 13 of 21 patients (62%) were classified as having a successful outcome objectively, and 17 of 21 (81%) were classified as having a successful outcome subjectively. The duration of the delay to definitive treatment was closely associated with the ultimate outcome (P < .01), as the outcome of only 1 of 7 elbows with a delay greater than 7 weeks was classified as an objective success. Of the patients, 19 had a fractured radial head, 11 of which were initially treated with a radial head excision; none was subsequently reconstructed. Sixteen patients were treated with a hinged external fixator. Of the elbows, 13 remained reduced whereas 8 had variable amounts of anterior or posterior instability. Two failures were ultimately reconstructed with a total elbow arthroplasty. Instability that persists after the initial unsuccessful management of a coronoid fracture and an elbow dislocation is a difficult problem to salvage with subsequent reconstruction. This experience emphasizes the need for better reconstructive options and especially underscores the need for appropriate initial management of this difficult injury.