Question 1

What is the coronoid process and why does it matter?

Accepted Answer

The coronoid process is a bony projection at the front of the ulna (forearm bone) that hooks into the front of the humerus (upper arm bone) when elbow is bent. It's one of the key structures preventing the elbow from dislocating backward. When coronoid fractures, especially if over 50% of its height (Type 3 fracture), the elbow becomes very unstable - it can subluxate (partially dislocate) or fully dislocate. This is why larger coronoid fractures almost always need surgery. Small tip fractures (Type 1) usually don't cause instability if isolated. The coronoid works with the lateral collateral ligament (LCL) and radial head to provide elbow stability - when all three injured (terrible triad), elbow is extremely unstable.

Question 2

What is the terrible triad injury?

Accepted Answer

The 'terrible triad' is the combination of: 1) Elbow dislocation (usually posterior - elbow dislocates backward), 2) Radial head fracture (the round knobby part of radius at elbow), 3) Coronoid fracture. This is called 'terrible' because it's one of the worst elbow injuries with high rates of complications: chronic instability, stiffness, arthritis, poor functional outcomes. Even with excellent surgery, 30-40% of patients have significant residual problems (loss of motion, weakness, pain). Treatment requires: relocating elbow, fixing coronoid, fixing or replacing radial head, repairing ligaments, often using hinged external fixator for protection. Very complex surgery 3-5 hours, prolonged recovery 6-12 months.

Question 3

Do all coronoid fractures need surgery?

Accepted Answer

NO - treatment depends on: 1) FRACTURE SIZE - Type 1 (tip fractures, under 2mm) often treated without surgery IF elbow stable. Type 2 (up to 50% of coronoid height) and Type 3 (over 50%) almost always need surgery. 2) ELBOW STABILITY - even small coronoid fractures need surgery if elbow unstable or subluxates. 3) ASSOCIATED INJURIES - if radial head fracture or ligament tears present, surgery usually needed even for smaller coronoid fractures. In practice: majority of coronoid fractures need surgery because they rarely occur in isolation - 85% occur with elbow dislocation which implies ligament damage. Only small isolated stable Type 1 fractures can be treated non-operatively (minority of cases).

Question 4

Will my elbow ever be completely normal again?

Accepted Answer

Honestly, probably not completely normal, but usually functional. Even with excellent surgery: 1) Loss of terminal extension (inability to fully straighten elbow) is very common - 40-50% lose 10-20 degrees. For most people this doesn't significantly limit function. 2) Some loss of strength compared to opposite elbow. 3) Weather-related aching or stiffness common. 4) Risk of post-traumatic arthritis in long term (10-20 years). HOWEVER: 70-80% achieve stable functional elbow able to perform daily activities without major limitations. Return to work, driving, most sports possible. Overhead athletes (pitchers, swimmers) may have more difficulty returning to pre-injury level. Results better for: younger patients, isolated coronoid fractures, anatomic reduction achieved at surgery.

Question 5

Why is stiffness such a big problem after coronoid fractures?

Accepted Answer

The elbow is NOTORIOUS for developing stiffness after injury and surgery. Reasons: 1) Elbow joint is very congruent (bones fit tightly) - any swelling or scar tissue causes stiffness. 2) Capsule (tissue around joint) easily becomes contracted and thick. 3) Muscles crossing elbow (biceps, triceps, brachialis) can develop adhesions. 4) Heterotopic ossification (abnormal bone formation outside the joint) occurs in 10-20% after elbow trauma. 5) Balance between protecting healing fracture (immobilization) versus preventing stiffness (motion) is difficult. This is why early motion is critical - hinged braces allow protected motion while healing. Even with perfect surgery and therapy, 40-50% have some permanent loss of motion. Prevention: immediate post-op motion in hinged brace, aggressive physical therapy, avoiding prolonged immobilization.

Medical Disclaimer

Coronoid Fracture (Elbow Bone Break)

📖What is Coronoid Fracture (Elbow Bone Break)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention