Coronoid as anterior buttress of ulnohumeral joint
Prevents posterior translation of ulna
Posterolateral rotatory instability
Tip fractures and lateral ligament complex injury association
Varus posteromedial instability
Anteromedial facet fracture association
Lateral collateral ligament injury association
Basal fractures
Greater loss of anterior stability
Higher likelihood of operative fixation
Therapeutic Considerations
Treatment rationale
Stable concentric reduction
Predictor of successful nonoperative pathway when maintained
Early protected motion
Stiffness risk with prolonged immobilization
Balance motion versus instability risk
Operative indications principles
Persistent instability or incongruent joint
Anteromedial facet fracture with varus instability
Large basal fragment with instability
Terrible triad pattern requiring stabilization
Evidence framing
Expert consensus supports early ortho evaluation for fracture-dislocation patterns
Class I recommendation by expert consensus for urgent management of neurovascular compromise
Patient Discharge Instructions
copy discharge instructions
Discharge instructions
Splint and sling
Keep splint clean and dry
Do not remove splint unless instructed
Swelling control
Elevation above heart level as much as possible for 48 to 72 hours
Ice 15 to 20 minutes at a time, several times daily, barrier between ice and skin
Pain plan
Acetaminophen as directed on label unless instructed otherwise
Ibuprofen as directed on label if safe for you
Opioid only if prescribed, avoid driving and alcohol
Activity limits
No lifting or pushing or pulling with injured arm
Keep fingers moving to reduce stiffness
Return to ED now for
Increasing pain not controlled with medication
New numbness or weakness in hand or fingers
Hand becoming cold, pale, or blue
Increasing tightness or swelling in forearm or hand
Splint too tight or causing pressure sores
Wet or broken splint
Fever or drainage from wound if any cut or puncture present
Follow-up
Orthopedics or fracture clinic within 3 to 7 days
Earlier follow-up within 24 to 72 hours if told your elbow is unstable or was dislocated
References
Clinical guidelines and evidence sources
Core references
Orthopedic trauma texts and consensus statements for elbow fracture-dislocations
Regan and Morrey coronoid classification original description
O'Driscoll classification for anteromedial facet and instability patterns
Procedural sedation guidance
ACEP Clinical Policy for procedural sedation and analgesia in the ED
Evidence levels ACEP Level A B C for sedation safety and monitoring recommendations
Trauma systems guidance
ATLS principles for neurovascular compromise and limb-threatening injury escalation
Coding and terminology sources
Coding references
ICD-10 S52.04 series for coronoid process of ulna fracture
SNOMED CT concepts for coronoid fracture and elbow dislocation
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