Description
Objectives
Fixation of the coronoid process or reinsertion of the anterior capsule is frequently required in elbow fracture-dislocations. Most of the times, it is carried out through a lateral approach, developing one or more bone tunnels from the dorsum of the ulna to the coronoid process to slide sutures (Lasso technique) or screws. Visualization and manipulation in the area is usually difficult, especially if the radial head does not require resection. Moreover, drilling the tunnels is often uncomfortable and unaccurate, eventually resulting in suboptimal exit points.
We aimed to develop a surgical guide to make this surgical step easier and more accurate. To our knowledge, no such device is available nowadays, and often surgeons need to use devices designed for other anatomical areas (E.g. pediatric anterior cruciate ligament guide).
Methods
A guiding device was designed specifically to facilitate the synthesis of the coronoid process. Emphasis was made on being simple, manageable with one hand, versatile for perforations of different diameters (Lasso osteosuture Vs osteosynthesis with screws), free-standing, and designed in few pieces to facilitate its sterilization. A first prototype is manufactured, and several successive tests are carried out on sawbones, on cadaveric specimens, and finally in clinical practice. A patent is registered.
Results
The guiding device met the design goals and showed its ability to keep the coronoid fractures reduced and stabilized, if necessary, while allowing accurately direct the exit of wires or drills from the dorsal aspect of the ulna to the desired exit points on the coronoid process.
Next objectives would be industrial development and commercial exploitation of this system.
Conclusions
Management of fracture-dislocations of the elbow often requires the coronoid fixation, a step that is carried out with no guidance or using guides designed for other anatomic areas.
We have developed an specific surgical device that can guide in a easy and accurate way the fixation of the coronoid process or the reinsertion of the anterior capsule to it, and have successfully tested it in laboratory and in clinics.
We look forward now for the industrial development and commercial exploitation of this system.
