Bone and Joint Institute

Varus posteromedial rotatory instability

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The Unstable Elbow: An Evidence-Based Approach to Evaluation and Management

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© Springer International Publishing Switzerland 2017. The coronoid is an important stabilizer of the elbow. Fractures of the anteromedial facet of the coronoid are thought to occur from a varus posteromedial rotatory force. Associated injuries can include disruption of the lateral collateral ligament and occasionally the medial collateral ligament. The gravity varus stress test is a physical examination method to detect subtle instability, but further studies to validate its use are required. Improved understanding of these injuries has led to the recognition that select anteromedial coronoid fractures can be treated nonoperatively. Current indications for nonoperative management include small, minimally displaced fractures without static joint malalignment/subluxation. In general, displaced or larger fractures may be preferentially treated surgically. Open reduction internal fixation may be performed using buttress plates, screws, and/or sutures. In most cases, the lateral collateral ligament should also be repaired. With a better appreciation of this injury pattern, the role of nonoperative management, and continued advances in surgical approaches and techniques, most patients with anteromedial facet fractures can expect good to excellent outcomes.