Arthroscopic Fixation of Coronoid Fractures: Antegrade Wire Technique

Coronoid process (CP) fractures are relatively uncommon, yet critical injuries to recognize. Arthroscopic reduction and fixation of coronoid process has been proposed to overcome these limitations of open approaches. Currently, arthroscopy is used to assist insertion of retrograde guide wire for a retrograde cannulated screw. This method is widely used; however it is technically challenging to direct the guide wire from dorsal aspect of ulna towards the tip of the coronoid. This chapter describes a new surgical procedure for arthroscopic-assisted fracture reduction and fixation of coronoid fractures. A technical modification of a standard elbow portal (anteromedial) allows the surgeons to obtain a better working angle for reduction of these fractures without requiring a cruciate ligament guide. This new accessory anteromedial portal permits fixation of the CP fracture using a more perpendicular angulation to the fracture line as compared to a standard anteromedial portal. This approach also abolishes completely the need for an anterior incision and dissection of the elbow capsule.