Lamberti Anna Gabriella, Lőrincz Aba, Molnár Tibor, Kassai Tamás, Nudelman Hermann, Józsa Gergő
Division of Surgery, Traumatology, Urology, and Otorhinolaryngology, Department of Pediatrics, Clinical Complex, University of Pécs, 7 József Atilla Street, 7623 Pécs, Hungary.
Department of Pediatric Traumatology, Péterfy Hospital, Manninger Jenő National Trauma Center, 17 Fiumei Street, 1081 Budapest, Hungary.
Life (Basel). 2025 Apr 6;15(4):614. doi: 10.3390/life15040614.
Coronoid process fractures in the pediatric population are rare and often misdiagnosed, leading to chronic elbow instability. We aim to evaluate the surgical management of two adolescent cases of inveterate coronoid fractures using autologous bone grafting. Both patients, with a history of recurrent elbow dislocations, presented with pseudoarthrosis and were initially misdiagnosed due to minor or subtle fractures. Comprehensive imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), confirmed the presence of significant coronoid defects. The surgical intervention involved employing autografts from the iliac wing to reconstruct the coronoid process, followed by fixation with screws. Both patients underwent postoperative rehabilitation via physiotherapy, resulting in full functional recovery. At their one-year follow-ups, both patients regained full elbow function, achieving range-of-motion measurements of 0-0-130° flexion-extension and 90-0-90° pronation-supination; no recurrence of instability was reported, with no complications at the yearly follow-ups. This approach demonstrates the efficacy of autograft reconstruction in restoring elbow stability, particularly in cases with substantial bone loss or pseudoarthrosis. Our study highlights the importance of advanced imaging and individualized treatment strategies, emphasizing that early surgical intervention can prevent long-term disability in pediatric patients with chronic coronoid fractures.
小儿冠状突骨折较为罕见，且常被误诊，从而导致慢性肘关节不稳定。我们旨在评估两例青少年陈旧性冠状突骨折采用自体骨移植的手术治疗方法。两名患者均有复发性肘关节脱位病史，表现为假关节形成，最初因骨折轻微或不明显而被误诊。包括计算机断层扫描（CT）和磁共振成像（MRI）在内的综合影像学检查证实存在明显的冠状突缺损。手术干预包括采用来自髂骨翼的自体骨移植来重建冠状突，随后用螺钉固定。两名患者术后均通过物理治疗进行康复，最终实现了功能完全恢复。在一年的随访中，两名患者均恢复了完全的肘关节功能，屈伸活动度达到0-0-130°，旋前旋后活动度达到90-0-90°；未报告不稳定复发情况，年度随访也未出现并发症。这种方法证明了自体骨移植重建在恢复肘关节稳定性方面的有效性，特别是在存在大量骨质流失或假关节形成的病例中。我们的研究强调了先进影像学检查和个体化治疗策略的重要性，强调早期手术干预可以预防慢性冠状突骨折小儿患者的长期残疾。
