Fractures of the coronoid process of the ulna are uncommon and often occur in association with elbow dislocation.
Fracture of the coronoid process is thought to result from elbow hyperextension with either avulsion of the brachialis tendon insertion, or shearing off by the trochlea1.
Coronoid process fractures have been classified into three types1:
Type 1 : avulsion of the tip of the coronoid process
Type 2 : fragment involving <50 % of the coronoid process
Type 3 : fragment involving > 50 % of the coronoid process
The prognostic relevance of this classification is contentious, but there is some correlation with the pattern of associated injuries: smaller fractures are more likely to be associated with the “terrible triad” pattern of injury, whereas larger fragments tend to occur with anterior and posterior fracture-dislocations of the olecranon2.
Coronoid process fractures may be diagnosed on a plain film series of the elbow, generally on a lateral or a 45° oblique view4. A CT may be necessary for fracture characterisation in the setting of a complex fracture-dislocation.
- 1. Regan W, Morrey B. Fractures of the coronoid process of the ulna. J Bone Joint Surg Am. 1989;71 (9): 1348-54. J Bone Joint Surg Am (abstract) - Pubmed citation
- 2. Doornberg JN, Ring D. Coronoid fracture patterns. J Hand Surg Am. 2006;31 (1): 45-52. doi:10.1016/j.jhsa.2005.08.014 - Pubmed citation
- 3. Doornberg JN, Van duijn J, Ring D. Coronoid fracture height in terrible-triad injuries. J Hand Surg Am. 31 (5): 794-7. doi:10.1016/j.jhsa.2006.01.004 - Pubmed citation
- 4. Tomás FJ. Alternative radiographic projections of the ulnar coronoid process. Br J Radiol. 2001;74 (884): 756-8. Br J Radiol (full text) - Pubmed citation