Injuries to the Coronoid Process of the Ulna with Involvement of the Lesser Sigmoid Notch

Abstract

Introduction This study aimed to describe the involvement of the lesser sigmoid notch in fractures to the coronoid process. We hypothesized that injuries to the lateral aspect of the coronoid process regularly involve the annular ligament insertion at the anterior lesser sigmoid notch.

Material and Methods Patients treated for a coronoid process fracture at our institution between 06/2011 and 07/2018 were included. We excluded patients < 18 years, patients with arthritic changes or previous operative treatment to the elbow, and patients with concomitant injuries to the proximal ulna. In patients with involvement of the lesser sigmoid notch, the coronoid height and fragment size (anteroposterior, mediolateral, and craniocaudal) were measured.

Results Seventy-two patients (mean age: 47 years ± 17.6) could be included in the study. Twenty-one patients (29.2%) had a fracture involving the lateral sigmoid notch. The mean anteroposterior fragment length was 7 ± 1.6 mm. The fragment affected a mean of 43 ± 10.8% of the coronoid height. The mean mediolateral size of the fragment was 10 ± 5.0 mm, and the mean cranio-caudal size was 7 ± 2.7 mm.

Conclusion Coronoid fractures regularly include the lesser sigmoid notch. These injuries possibly affect the anterior annular ligament insertion which is important for the stability of the proximal radioulnar joint and varus stability of the elbow.

Zusammenfassung

Ziel Ziel dieser Untersuchung war es, die Beteiligung der Incisura radialis ulnae bei Frakturen des Proc. coronoideus ulnae zu untersuchen. Hypothese der Studie war es, dass bei Verletzungen des lateralen Proc. coronoideus ulnae regelmäßig die Bandinsertion des Lig. anulare der Incisura radialis ulnae beteiligt ist.

Methoden Patienten, die mit einer Fraktur des Proc. coronoideus ulnae zwischen 06/2011 und 07/2018 in unserer Institution behandelt wurden, wurden in diese Untersuchung eingeschlossen. Ausgeschlossen wurden alle Patienten < 18 Jahren, mit arthrotischen Veränderungen oder vorangegangenen Operationen am Ellenbogen sowie bei begleitenden Verletzungen der proximalen Ulna. Bei Beteiligung der Incisura radialis ulnae wurden die Frakturfragmente (anterio–posterior, medio-lateral und kraniokaudal) sowie die Koronoidhöhe standardisiert in der CT vermessen.

Ergebnisse Insgesamt konnten 72 Patienten mit einem Alter von 47 ± 17,6 Jahren eingeschlossen werden. Hiervon zeigten 21 Patienten (29,2%) eine Beteiligung der Incisura radialis ulnae. Die mittlere anterio–posteriore Fragmentgröße war 7 ± 1,6 mm, im Mittel waren 43 ± 10,8% der Koronoidhöhe beteiligt. Die mittlere medio-laterale Fragmentgröße war 10 ± 5,0 mm, die kraniokaudalen Ausmaße 7 ± 2,7 mm.

Schlussfolgerung Frakturen des Proc. coronoideus ulnae involvieren regelmäßig die Incisura radialis ulnae. Diese Verletzungen können die Insertion des Lig. anulare umfassen, welches für die Stabilität des proximalen Radioulnargelenks sowie für eine Varusstabilität des Ellenbogens entscheidend ist.

Key words

elbow - terrible triad - fracture

Schlüsselwörter

Ellenbogen - Terrible triad - Fraktur

Publication History

Article published online:
15 October 2020

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