Advances in the treatment of O'Driscoll type II fractures of the coronoid process of ulna
10.3760/cma.j.cn121113-20250124-00079
- VernacularTitle:尺骨冠突O'DriscollⅡ型骨折的治疗进展
- Author:
Wuqiang JIANG
1
;
Zhe SONG
1
Author Information
1. 西安交通大学附属红会医院骨创伤医院老年骨科，西安 710054
- Publication Type:Journal Article
- Keywords:
Ulna fractures;
Surgical procedures, operative;
Treatment outcome;
Review
- From:
Chinese Journal of Orthopaedics
2025;45(13):886-891
- CountryChina
- Language:Chinese
-
Abstract:
Ulnar coronoid process fractures are frequently associated with complex elbow injuries, and their optimal management remains a long-term concern in clinical practice. In particular, there are many controversies regarding whether surgical treatment is required for O'Driscoll type II ulnar coronoid process fractures, the size of the bone block that needs to be fixed, and the surgical approach and internal fixation method to be adopted, with significant controversy particularly surrounding O'Driscoll Type II fractures regarding the necessity of surgical intervention, the fragment size threshold mandating fixation, and the choice of surgical approach and internal fixation method. O'Driscoll Type II fractures involve the anteromedial facet of the coronoid and are subdivided into Type IIa (fracture line extending from the medial aspect of the coronoid tip to the anterior half of the anteromedial facet), Type IIb (similar to IIa but involving the coronoid tip), and Type IIc (fracture extending to the anteromedial rim and the entire anteromedial facet). While surgery for Type II fractures was historically indicated based on fragment size >5 mm, recent studies advocated determining the need for surgical management through a comprehensive assessment of elbow joint stability. Regarding surgical exposure of ulnar coronoid process fracture: the Hotchkiss over-the-top approach is suitable for Type II anteromedial facet fractures without medial collateral ligament (MCL) injury; the FCU-Split approach is indicated for Type II fractures requiring MCL repair; the Taylor-Scham approach is used for injuries involving posteromedial coronoid fractures; the Extensile Medial Elbow approach is applicable for Type III fractures with trochlear injury; the Kocher lateral approach is more appropriate for coronoid fractures combined with radial head fractures. Fixation methods include suture lasso techniques, anchor sutures, screws, or plates, selected based on fracture location, fragment size, and biomechanical requirements. Major postoperative complications include ulnar neuropathy and elbow stiffness, along with osteoarthritis, heterotopic ossification, hardware prominence/exposure, elbow instability, infection, screw loosening, and complex regional pain syndrome.
