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NewsA tricky elbow injury, successfully fixed. Surgeons treated a 37-year-old polytrauma patient with a rare transulnar basal coronoid fracture-dislocation — a complex elbow injury where the coronoid bone fragment separates entirely from the surrounding ulna. Using a single posterior incision, the team achieved full elbow stability, and the patient returned to unrestricted work by 3.5 months.
After a high-speed motor vehicle accident, a 37-year-old man arrived in hemorrhagic shock with injuries spanning his sternum, ribs, pelvis, and both upper extremities. Among the most complex: a transulnar basal coronoid fracture-dislocation of the left elbow — a rare injury where the coronoid fragment detaches from both the olecranon and ulnar metaphysis, making it particularly difficult to identify and treat.
Once stabilized, surgeons performed open reduction internal fixation of the left elbow through a single posterior incision. A reduction clamp was used to reposition the detached coronoid fragment, confirmed via fluoroscopy, without needing an additional medial or anterior approach. The radial head reduced concentrically once the proximal ulna was restored, and the elbow remained stable through a full range of motion intraoperatively.
Key Takeaways:
Why it matters: This injury pattern is often misclassified, and missing the separate coronoid fragment can lead to persistent elbow instability and the need for revision surgery. This case highlights that careful preoperative imaging and deliberate intraoperative technique — even through a single posterior approach — can yield excellent early functional outcomes.
