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Treatment of Proximal Trans-ulnar Fracture-Dislocations Based on a Step-By-Step
Coronoid-Centric Surgical Technique: Proposal of a Surgical Algorithm Based on
Coronoid Management and Windows Approach
#MMPMID41112699
Blonna D
; Garruto S
; Caranzano FF
; Pascucci F
; Hoxha N
; Bonasia DE
; Rossi R
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41112699
show ga
INTRODUCTION: Complex proximal ulna fractures that are associated with radial
head dislocation or fracture-dislocation, often referred to as "Monteggia-like"
or trans-ulnar fracture-dislocations, constitute a heterogeneous group that poses
challenges for classification and treatment. Management often relies on surgeon
expertise rather than systematic approaches, leading to poor outcomes, high
complication rates, and frequent surgical revisions. We hypothesize that a
systematic, coronoid-centric, step-by-step surgical technique could improve
outcomes in trans-ulnar fracture-dislocations. METHODS: A retrospective study was
conducted on patients with trans-ulnar fracture-dislocations treated between 2017
and 2023. Exclusion criteria included patients younger than 18 years, open
fractures beyond Gustilo grade 1, and follow-up shorter than 12 months. Fractures
were classified using the coronoid-centric Mayo classification based on
preoperative radiographs and CT scans. Two additional fracture patterns,
characterized by distinct coronoid detachment features, were identified. Outcomes
were evaluated through subjective elbow scores Subjective Elbow Value, Mayo Elbow
Performance Score (MEPS), Oxford Elbow Score, QuickDASH, and range of motion
(ROM) evaluations. RESULTS: Among the 39 patients included, the most common
fracture pattern was the trans-ulnar basal coronoid fracture-dislocation (49%).
At a mean follow-up of 3.9 years (range 1-7), 90% (35/39) of the patients
achieved a functional ROM. The mean MEPS was 85 (range 60-100), and the mean
QuickDASH was 18 (range 0-45). The revision rate was 13% (5/39), due to coronoid
nonunion (n = 1), olecranon fixation failure after a new trauma (n = 1), and
elbow stiffness (n = 3). Ulnar nerve neuropathy was recorded in 2 of 39 patients.
DISCUSSION: A systematic, coronoid-centric surgical approach led to satisfactory
outcomes in trans-ulnar fracture-dislocation with an acceptable rate of
complication and revision rate. Recognizing the prognostic value of the coronoid
may reduce complication rates. LEVEL OF EVIDENCE: Level III. See Instructions for
Authors for a complete description of levels of evidence.
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