Coronoid Process Fracture

BackgroundClassification Coronoid Fractures


The coronoid is the most important portion of ulno-humeral articulation



1.  Provides anterior buttress

2.  Anterior capsule and brachialis attach to coronoid

2.  Anterior band of the MCL attaches to it

- distally and medially on sublime tubercle


Instability rises and prognosis deteriorates according to the amount of coronoid process that is fractured


Fracture patterns



Anteromedial facet fragment




Most commonly associated with elbow dislocations

Anteromedial facet fractures may be caused by varus / rotational force


Regan and Morrey Classification


Coronoid Process Classification


Type I 

- usually stable

- shear fracture not avulsion fracture

- may rarely cause residual instability in elbow dislocation


Coronoid Fracture Type 1Coronoid Fracture Type 1 CT


Type II 

- 50% coronoid

- elbow usually unstable

- lose attachment of capsule

- ORIF screws or sutures

- any ? about stability use hinged fixator


Coronoid Fracture Type 2


Type III

- > 50% coronoid

- Uncommon

- unstable as lose capsule +/- MCL with anteromedial fragment

- ORIF with screw / sutures / anteromedial buttress plate

- again may need hinged fixator


Type 3 Coronoid FractureCoronoid Fracture Type 3


Operative Management


Surgical approach


1.  Universal posterior approach

- if performing surgery for complex dislocation

- allows medial and lateral access to joint


2.  Lateral approach through radial head

- if excising radial head, then replacing


3.  Medial approach

- isolate and protect ulna nerve  

- elevation of ulna origin of flexor pronator group anterior to FCU

- important if fracture is anteromedial


4.  Approach through fractured olecranon




Type 1

- capsular suture repair


Type 2 / 3

A.  Screws (AP or PA)

B.  Pass sutures through capsule and tie over drill holes in ulna


Anteromedial fragment

- medial approach / buttress plate


Coronoid Process Buttress Plate


Unrepairable / unstable

- reconstruct with radial head, iliac crest, or allograft