Medial elbow approach via a medial epicondyle osteotomy

OBJECTIVE: To describe a medial epicondyle osteotomy technique to approach the coronoid from the medial side and to present the outcome of our patients. INDICATIONS: Displaced coronoid fractures (particularly O'Driscoll anteromedial subtypes 1-3 and basal subtypes 1 and 2 fractures). CONTRAINDICATIONS: Infected or compromised skin on the medial elbow. SURGICAL TECHNIQUE: A curvilinear incision centered over the anterior aspect of the medial epicondyle is performed. The ulnar nerve is released. The medial epicondyle is osteotomized in a trajectory that parallels both the medial trochlea and the fibers of the flexor-pronator mass, from posterior to anterior. This is performed with a sagittal saw and completed with an osteotome. The flexor pronator mass and medial ulnar collateral ligament (MUCL) are reflected distally and the anterior capsule is elevated to expose the articular surface of the ulnohumeral joint. The coronoid fracture is anatomically reduced and fixed with either (headless) compression screws or a (anatomic) buttress plate, depending on the fracture configuration. The medial epicondyle is reduced and fixed in place with two diverging cortical screws (2.7 or 3.5 mm). A stable construct should be achieved to allow for early mobilization. POSTOPERATIVE MANAGEMENT: Free range of motion exercises can be initiated immediately. At 6 weeks, strength exercises can be initiated. At 12 weeks, the patient may return to activities as tolerated. RESULTS: In all, 13 patients (7 men and 6 women; ages 20-62 years old) underwent fixation of their complex coronoid fractures through a medial epicondyle osteotomy. Average elbow flexion-extension arc of motion was 118° and average pronation-supination arc of motion was 154°. One complication was reported in a patient who required revision fixation of the medial epicondyle osteotomy.