Pediatric Olecranon Fracture with Coronoid Process Osteochondral Flap Fracture: A Rare and Challenging Case
DOI:
https://doi.org/10.56929/jseaortho-2024-0208Keywords:
Osteochondral flap fracture, coronoid osteochondral flap, pediatric coronoid process fractureAbstract
Purpose: Osteochondral flap fracture is a variant of fracture in the pediatric age group. It is caused by a shearing force that separates the articular cartilage from the underlying subchondral bone. We present a pediatric case of an olecranon process fracture with an osteochondral flap fracture of the coronoid process.
Case report: A 10-year-old child presented with swelling and pain in the right elbow after an incident of direct trauma. A plain radiograph revealed multiple small fracture fragments, inconclusive of coronoid process involvement. Intraoperatively, we found an osteochondral fracture of the coronoid process with anteromedial facet displacement. The fracture was reduced and secured with two K-wires. The undisplaced olecranon fracture was fixed with a K-wire in situ.
Conclusions: Osteochondral flap fractures of the coronoid process can be easily missed and underestimated in imaging studies. Neglected fractures can lead to severe impairment of elbow motion and function and cause chronic pain. The anatomical reduction of the coronoid facet is crucial and yields the best outcome.
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References
Wang J, Wang Z. Osteochondral flap fracture of the coronoid in pediatric humeral lateral condyle: A report of 3 cases. Medicine (Baltimore) 2019;98:e15915. DOI: https://doi.org/10.1097/MD.0000000000015915
Valisena S, Hamitaga F, Gonzalez JG, et al. Osteochondral flap fracture of the coronoid in pediatric elbow dislocation: a case report and literature review. Eur J Orthop Surg Traumatol 2019;29:213-20. DOI: https://doi.org/10.1007/s00590-018-2294-8
Arnold RM, Fehringer EV. Displaced basal coronoid fracture and fixation in a 7 year old: A case report and review of the literature. Shoulder Elbow 2009;1:104-7. DOI: https://doi.org/10.1111/j.1758-5740.2009.00029.x
Kim DC, Cutchen W, Teachey W, et al. Pediatric olecranon osteochondral flap Fractures with subtle radiographic abnormality. J Hand Surg Am 2021;46:155.e1-8. DOI: https://doi.org/10.1016/j.jhsa.2020.03.020
Salzmann GM, Niemeyer P, Hochrein A, et al. Articular cartilage repair of the knee in children and adolescents. Orthop J Sports Med 2018;6:2325967118760190. DOI: https://doi.org/10.1177/2325967118760190
O'Driscoll SW, Jupiter JB, Cohen MS, et al. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect 2003:52:113-34.
Yamaura K, Inui A, Mifune Y, et al. Anterior transolecranon fracture dislocation with an associated avulsion fracture of coronoid process of ulna in a child: a case report. JSES Int 2020;5:9-12. DOI: https://doi.org/10.1016/j.jseint.2020.10.005
Varacallo M, Mody KS, Parikh D, et al. Physical examination of the pediatric elbow. In: Abzug J, Herman M, Kozin S, editors. Pediatric elbow fractures: a clinical guide to management. Springer; 2018. p.13-21. DOI: https://doi.org/10.1007/978-3-319-68004-0_2
Karbach LE, Elfar J. Elbow instability: anatomy, biomechanics, diagnostic maneuvers, and testing. J Hand Surg Am 2017;42:118-26. DOI: https://doi.org/10.1016/j.jhsa.2016.11.025
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