The impact of suture fixation on elbow extension and clinical outcomes in coronoid tip fractures in terrible triad injuries

This study aimed to evaluate the effect of coronoid/anterior capsule fixation on long-term clinical and radiological outcomes, complication rates, and the need for revision in patients with type 1 coronoid fractures associated with terrible triad elbow injury (TTEI). We hypothesized that coronoid fixation would not provide significant functional benefits and might lead to increased complication rates, particularly extension limitation due to anterior capsular tightness. A retrospective analysis was conducted on 30 patients (mean age 51 years) who underwent surgical treatment for TTEI with type 1 coronoid fractures between 2012 and 2022. Patients were grouped into those who received coronoid fixation (n=13) and those who did not (n=17). Clinical and radiological outcomes were evaluated using Mayo Elbow Performance Score (MEPS), Quick DASH score, range of motion, and radiographic assessment of joint stability and arthrosis. Complication rates and reoperation requirements were also recorded. There were no significant differences between the groups in demographic or surgical variables. The coronoid fixation group showed a higher mean extension deficit (17°) compared to the non-fixation group (6°) (p=0.006). Complications occurred more frequently in the coronoid fixation group (53%) than in the non-fixation group (35%), although this difference was not statistically significant (p=0.516). Reoperation rates were also higher in the fixation group. Coronoid fixation in type 1 coronoid fractures associated with TTEI did not provide functional advantages and was associated with higher complication and reoperation rates. Extension limitation due to anterior capsular tightness was more common in the fixation group. These findings suggest that routine coronoid fixation may not be necessary for type 1 fractures. Further prospective studies are needed to confirm these results.