Fixation of Regan-Morrey Type II Coronoid Fractures: A Comparison of Screws and Suture Lasso Technique for Resistance to Displacement

Nicholas P Iannuzzi, Adrian G Paez, Brent G Parks, Michael S Murphy
Journal of Hand Surgery 2017, 42 (1): e11-e14

PURPOSE: The aim of this study was to compare the load to failure and stiffness achieved in coronoid fractures treated with a posterior-to-anterior screw versus a suture lasso technique.

METHODS: We performed a biomechanical study using 10 pairs of fresh-frozen cadaveric elbows. A transverse osteotomy at the midpoint of the coronoid height was created to simulate a Regan-Morrey type II coronoid fracture. The specimens were randomized to screw fixation or suture lasso fixation. The load to failure and stiffness were then measured using a materials testing machine.

RESULTS: Screw fixation provided greater strength and stiffness than suture lasso fixation. Mean load to failure was 405 N in the screw fixation group compared with a load to failure of 207 N for suture fixation. Screw fixation resulted in a mean stiffness of 284 kPa/mm compared with 119 kPa/mm after suture fixation.

CONCLUSIONS: Screw fixation was biomechanically superior to fixation using a suture lasso technique. For coronoid fractures in which screw or suture fixation is feasible, screw fixation may provide greater resistance to displacement of the coronoid compared with a suture lasso technique.

CLINICAL RELEVANCE: Clinical studies have reported a higher rate of failure after screw fixation compared with suture lasso fixation; however, this study demonstrated a greater stiffness and load to failure after screw fixation of type II coronoid fractures. Screw fixation may provide a stronger fixation construct for fractures of adequate size to support a screw. Further studies may be warranted to assess the importance of securing the anterior capsule to the coronoid tip when using a suture lasso construct because this may affect the stability of the elbow after fixation.

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