• Enrico Bellato, Roberto Rotini, Alessandro Marinelli, Enrico Guerra, and Shawn W O'Driscoll.
• Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedics and Traumatology, University of Turin Medical School, Turin, Italy.
• J Shoulder Elbow Surg. 2016 Dec 1; 25 (12): 2071-2077.

BackgroundChronic coronoid deficiency can occur subsequent to coronoid fracture malunion/nonunion or to coronoid hypoplasia or dysplasia resulting from injury during development. Several surgical options have been described to treat this difficult condition, but results are equivocal. We hypothesized that a modified coronoid reconstruction using a radial head osteochondral graft could restore elbow stability and congruity and that a technique involving rigid internal fixation would promote graft union.MethodsThe coronoid was reconstructed using an osteochondral fragment from a frozen allograft radial head in 3 young women affected by complex post-traumatic elbow instability and incongruity resulting from coronoid deficiency. To promote bone healing, the fragment was kept as large as could be fitted in place, the cut surface compressed onto the remaining coronoid was as large as possible, the medial portion of the radial head (containing dense bone) was used, and 3 lag screws were inserted in different directions.ResultsAt a mean follow-up of 26 months, all 3 patients achieved a painless, congruent stable joint with a functional range of motion. Computed tomography scans performed 3 months after surgery showed complete union of the graft in all the patients. Each patient rated herself as "almost normal" or "greatly improved" on the Summary Outcome Determination scale.ConclusionCoronoid reconstruction with a radial head osteochondral allograft was successful in restoring stability and function in chronically unstable elbows with coronoid deficiency. Strong fixation using a large segment of the medial radial head achieved rapid graft healing.Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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