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Forum Name: Bone trauma and fractures

Question: Competitive Gymnast with Coronoid Fracture


 Xyrodon - Sun Apr 12, 2009 9:19 pm

Hey everyone,

I'm new to this forum and I came here in search of help and advice. While doing a pass on floor exercise in gymnastics, I feel backwards, hyper-extended my elbow and dislocated it. Combined with this dislocation, the orthopedic physician also informed me that I had a type 1 fracture of my coronoid. Everything I have researched about fractured coronoids has me very despondent. I don't want to lose the flexion and extension of my elbow and I'm scared I'll never do gymnastics again. Is it possible for someone to regain full mobility and range of motion of their elbow after this type of fracture?

Please help..
 Tom Plamondon PA-C - Mon Apr 20, 2009 3:01 pm

User avatar Hello,
The terrible triad of the elbow is dislocation, fracture coronoid and fracture radial head.
Sounds like this was a terrible biad (no fractured radial head).
Since the fracture was classified as type I, that means the tip of the proximal ulnar was chipped off (versus types II and III in which the coronoid portion of the ulnar shatters into multiple pieces).
With rehab, you should be able to regain full mobility of the elbow but it will take some time.
Did the orthopedist fix the fracture with sutures or a screw? And are you allowed to do range of motion exercises yet.
Take care and let us know how it goes.
 Xyrodon - Fri Jan 29, 2010 4:32 pm

Whoa, thanks for the reply, I greatly appreciate that. I know this is a bit late, but my injury has taken a turn for the worse. I was splinted for one week, then I was in a sling for about 4 more weeks. The physician (who was orthopedic surgeon, although not a very good one IMO) just told me to do some simple ROM exercises to re-gain my mobility. I also work as a Kinesiologist and did some ultrasound on myself along with ROM exercises. I saw a Physiotherapist, who did some manual manipulation of my elbow to increase the ROM, however it has not really improved. I even tried acupuncture.
My elbow range currently both in extension and definitely in flexion has decreased. If I sleep on my arm it's quite numb in the morning. Physical activity for me wasn't too bad a couple of months ago. I was actually starting to get back into my gymnastics training. Now my elbow hurt tremendously again. I feel I've exhausted so many options for treatment and I'm not sure what to do anymore. Most physicians in Canada just look at me and shrug, followed with a "if it hurts then don't do it" but that now includes so many things. By the way, and strangely enough, the pain is not anywhere near my coronoid. All of the pain I feel in both extension and flexion is located near my medial epicondyle. Any thoughts? Advice? I'm extremely frustrated and now I fear for the long term effect of the injury..
 Dr. A. Saif - Sat Feb 27, 2010 4:55 pm

User avatar Dear Xyrodon,

Trouble is that the coronoid fracture is a actually only a small part of your injury. A joint is not meant to dislocate, (err... was that obvious?), so there are structures about that stop you elbow dislocating. Your coronoid process is just one. By the sounds of things, only a small segment of the coronoid was involved (type I means only a 1/3 or less involved), otherwise you would have had surgery to fix it. You must therefore have also damaged the joint capsule and probably the medial collateral ligament. These are not visible to X-rays.

So how do you manage this? Well the elbow is vulnerable to redislocation. This should be assessed at the time of reduction of the elbow. If the elbow is unstable, then clearly some protection is needed. The downside of splinatge however is the way th body heals. It heals with scar tissue, your body's glue. It stick broken bits together and torn structures get enveloped in this mass of fibrous and inelastic tissue. Result... a stable but stiff elbow.

How to manage? Well, aggressive physiotherapy sounds initially like a good idea. In the olden days it was actually considered a no-no. That's because aggressive physiotherapy it had been suggested leg actually to progressive increasing stiffness; it was thought this was due the injury of physiotherapy itself leading to more scar tissue. The result is that orthopaedic surgeons generally say no to passive exercises of the elbow...only do active exercises within limits of pain. Passive stretching therefore would have been contra-indicated and possibly (only possibly) harmful; I know physiotherapists and surgeons who have quite conflicting opinions on the issue.

Worst case scenario? You could get a condition called myositis ossificans...what's that? I am not supposed to be scaring you? Ooops sorry..withdraw that remark. pretend I didn't put that in...myo what? never heard of it...

How would I proceed? Review with your orthopaedic surgeon. I can not comment without having you in front of me...but if we are certain you are not getting better, and want to go the next step up the therapeutic ladder... I would probably arrange an MRI scan and follow this up with an arthroscopic athrolysis, after putting in my usual get out clause..."this might make you better, but could make you worse"

Good luck

Saif

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