Ossification of the posterior capitellum: description of a new pathology and its radiological appearance.

BACKGROUND: Boxer elbow and handball goalkeeper elbow are causes of impingement characterized by osteophytes formation at the olecranon and coronoid tip as well as their corresponding fossae. Herein, we present another distinct pathology in these patients: the formation of an exostosis at the posterolateral aspect of the elbow. METHODS: Between April 2016 and May 2020, 12 athletes with boxer elbow and handball goalkeeper elbow (mean age of 22 years) suffering from elbow pain were enrolled in the present study. Plain radiography, magnetic resonance imaging (MRI), and computer tomography (CT) scans were used to evaluate the bone conformation of the posterolateral aspect of the elbow. Assessment and staging of the ossification was performed by two independent fellowship-trained elbow surgeons. RESULTS: Bone marrow edema of the posterior aspect of the elbow at the origin of the anconeus muscle was initially detected in MRI scans. With the progression of the condition, imaging revealed an ossification posterior to the capitellum with bony bridges. In the advanced stage of the disease, the exostoses was unstable as the ossification had no adherence to the posterior capitellum during surgical excision. Plain radiographs are limited in their ability to detect the condition, whereas MRI and CT scans allow to identify a signal enhancement at the posterolateral aspect of the elbow. CONCLUSION: In patients without history of elbow trauma, bony irregularities of the posterior aspect of the capitellum may indicate ossification of the posterolateral aspect of the elbow, most likely caused by repetitive hyperextensions.

Overlengthening of the radial column in radial head replacement: a review of the literature and presentation of a classification system.

BACKGROUND: Radial head arthroplasty is a common procedure in elbow surgery. It has been shown to be of benefit for the patients, but there also are relevant complications that should be prevented if possible. One significant complication is overlengthening of the radial head prosthesis. In overlengthening, the head of the prosthesis overextends the physiological level of the native radial head and leads to overcompression in the radiohumeral joint. Rapid erosion and arthritic changes may then impede the clinical outcome. The incidence of overlengthening is not precisely known, but estimations range to up to 20% of all implanted prostheses. METHODS: The present review discusses the available body of literature on overlengthening and lines out a classification system that may be used to guide treatment algorithms. The classification is based on the personal experiences of the author during their clinical practice. RESULTS: In low-grade overlengthening (type I) conservative treatment can be an option. In Types II-IV usually revision surgery is needed. Depending on the state of the capitulum and joint stability, it is possible re-implant a prosthesis, or rely on implant removal alone. DISCUSSION: The present review aimed at shedding light into overlengthening as a complication radial head replacement and to help identify and treat it.

[Bony contact in arthritic and healthy elbow joints : Studies in cadaveric specimens]. / Knöcherne Kontaktpunkte im arthrotischen und gesunden Ellenbogengelenk : Studie am humanen Leichenpräparat.

BACKGROUND: Arthroscopic and open debridement arthroplasty for elbow arthrosis produce excellent results. Resection of the tip of the olecranon and coronoid, as well as debridement of the associated fossae, is frequently described as sufficient for restoring range of motion and reducing pain. OBJECTIVES: The purpose of this study was to demonstrate that medial and lateral osteophytes of the olecranon and the coronoid usually mark the first bony contact and may, therefore, restrict range of motion. MATERIAL AND METHODS: 11 fresh-frozen elbows were dissected. The fossae were coated with Optosil P Plus (C-silicone), and maximal flexion and extension was simulated. The distribution of C­silicone impressions was documented. 6/7 donors were male. The mean age at the time of death was 82 . RESULTS: Out of 11 elbows, 4 exhibited arthritic changes. All arthritic elbows showed marginal osteophytes of the olecranon without characteristic dipping of the olecranon into its fossa. In 1/4 cases, additional osteophytes at the side of the coronoid were detected (in comparison to 1/7 in healthy elbows). CONCLUSION: The distribution of osteophytes in elbow arthrosis may be underestimated. Many clinicians describe a resection of the tip of the olecranon and the coronoid and debridement of the related fossa as sufficient. Our study supports the theory that marginal osteophytes, especially of the olecranon, should be resected during debridement arthroplasty, since the distribution of bony contact differs in arthritic and healthy elbows.

[Performance control after arthroscopic arthrolysis with capsulectomy in fresh-frozen elbow joints]. / Erfolgskontrolle nach arthroskopischer Arthrolyse mit Kapsulektomie am Ellenbogengelenk im Fresh-frozen-Präparat.

BACKGROUND AND OBJECTIVE: Posttraumatic or postoperative movement restrictions in elbow joints can often occur (including capsular contracture) and can generate everyday limitations. In persistent elbow stiffness, arthroscopic arthrolysis with removal of the dorsal and ventral capsule portions can be carried out. The purpose of this study was to assess the efficacy of arthroscopic capsulectomy by means of an in vitro anatomical study. METHODS: A standardized elbow arthroscopy with ventral and dorsal capsulectomy was performed and image-documented in five fresh-frozen elbow specimens. Subsequently, open dissection of the elbow joint was performed to analyze the amount of residual capsule by means of photodocumentation of the specimens. RESULTS: Regardless of the surgeon and surgical experience, anterior and posterior remnants of the capsule remained in all specimens. Dorsal capsule strands around the standard arthroscopy portals were noticed particularly more often in the area of the high dorsolateral camera portal. An incomplete capsulectomy was seen on the ulnar side at the level of the posterior medial ligament (PML) in the immediate vicinity of the ulnar nerve. Ventrally, a capsulectomy was performed from the radial side and also the ulnar side until the brachialis muscle and additionally a complete capsulectomy as far as the anterior medial ligament (AML) and radial collateral ligament (RCL) was achieved. The capsule was completely resected in a proximal direction. Distally, irrelevant capsular remnants were found in the region of the annular ligament and distal of the tip of the coronoid process. CONCLUSION: Arthroscopic arthrolysis can be performed with a high degree of radicality. The radicality must be self-critically taken into account in one's own action. The radicality of the portal change may even be higher ventrally than with an isolated column procedure. On the other hand, it must be critically considered that posteriorly, the PML cannot be adequately addressed by means of arthroscopy due to the risk of ulnar nerve injury. Portal changes might help to enable a more complete visualization of the joint capsule and may avoid leaving possibly relevant remnants of the capsule. If a release of the PML is required, this may have to be carried out in combination with an ulnar nerve release in a mini-open technique.

Correction to: Insertion of the Ascension PyroCarbon PIP total joint in 152 human cadaver fingers: analysis of implant positions and malpositions.

In the experimental study the distal component of the Ascension PyroCarbon proximal interphalangeal total joint prosthesis was implanted 180° rotated. Figures 2-5 show the implant malpositions. The methods, results, and conclusion of the study were not affected by this.

[The proximal radioulnar joint in consideration of the distal radioulnar joint]. / Das proximale Radioulnargelenk unter Berücksichtigung des distalen Radioulnargelenks.

The movement of the forearm follows a complex interplay of three main components: the proximal and distal radioulnar joint and the interosseous membrane. Injuries to one or even all components have a huge impact on the integrity of this system. The Essex-Lopresti lesion presented a high challenge in clinical diagnostics as well as therapy. Reconstructions of the length and stability are essential for a satisfactory postoperative outcome. If a reconstruction of the radial head by osteosynthesis is not possible, a radial head prosthesis should be implanted in the case of longitudinal instability - avoiding overlapping and/or oversizing. The reconstruction of the interosseous membrane should be considered, as well as the assessment of the distal radioulnar joint and/or the triangular fibrocartilage complex. Various reconstruction options are available in this regard.

[Destruction of the radial head : Endoprosthesis, autologous reconstruction or anconeus arthroplasty?] / Destruktion des Radiuskopfes : Endoprothese, autologer Aufbau oder Anconeusplastik?

BACKGROUND: Radiocapitellar arthritis or defects most often result from trauma. Most of the patients are young and have high functional demands with high load capacities. Therefore, endoprosthetic options should be postponed for as long as possible. If conservative treatment cannot relieve symptoms sufficiently, radial head preservation, resection or replacement options are at the surgeon's disposal. In early stages of radiocapitellar arthritis, radial head preservation options can be taken into account. The chances ofgood results decrease with increasing cartilage damage. TREATMENT OPTIONS: In addition to radial head preservation options this article discusses radial head resection with and without anconeus interposition and radial head as well as radiocapitellar replacement. Clinical data are rare. The advantages and disadvantages of each option must be discussed with the patient and the decision should be made individually on the basis of patient specific factors. The aim must be to postpone endoprosthetic options - especially total elbow arthroplasty - for as long as possible, while assuring a functional range of motion with an acceptable pain level.

[Post-traumatic arthritis in the young patient : Treatment options before the endoprosthesis]. / Die posttraumatische Arthrose des jungen Patienten : Therapieoptionen vor der Endoprothese.

BACKGROUND: In the young patient, treatment of post-traumatic elbow arthritis remains difficult. Total elbow arthroplasty must be delayed for as long as possible. Therapy starts with nonoperative treatment. If this fails, operative options can be discussed. TREATMENT AIM: The aim of surgery is to provide a functional range of motion with acceptable pain without obstructing future treatment options. THERAPY: Patients with pain at terminal extension and/or flexion may benefit from arthroscopic or open debridement. Patients with advanced osteoarthritis and pain throughout the complete range of motion, who are too young for total elbow arthroplasty, are offered interposition arthroplasty or arthrodesis. Arthrodesis of the elbow leads to significant restrictions in daily life due to the complete loss of extension/flexion. Therefore, arthrodesis is only offered as treatment in exceptional circumstances. Interposition arthroplasty is a reasonable option for the young patient without significant bony defects, which may provide a stable, functional flexion arc with an acceptable pain level. Interposition arthroplasty preserves the revision options of re-interposition arthroplasty as well as the withdrawal to total elbow arthroplasty. Partial and total elbow arthroplasty are treatment options of elbow arthritis but are not subjects of this article.

Insertion of the Ascension PyroCarbon PIP total joint in 152 human cadaver fingers: analysis of implant positions and malpositions.

INTRODUCTION: The Ascension PyroCarbon proximal interphalangeal (PIP) total joint is used in osteoarthritis of the PIP finger joint. No systematic study of the positioning of this prosthesis and its relation to proximal and middle phalanx morphology has yet been reported. MATERIALS AND METHODS: Positioning of the proximal and distal components of the Ascension PyroCarbon PIP total joint was radiographically analysed in 152 human cadaver fingers. RESULTS: Ideal implant position in the axis of the phalanx and with contact of the implant head with bone in both the frontal and sagittal planes was seen in only 33 % of the phalanges. Implant malposition was observed in the remaining 67 % of phalanges. CONCLUSION: The current design of the Ascension PyroCarbon PIP total joint can lead to malpositioning that we attribute to its incomplete accommodation of the morphology of the proximal and middle phalanx, the surgical challenges the design poses, or both acting together.

Identification of overlengthening after replacement of the radial head with a bipolar prosthesis.

INTRODUCTION: Overlengthening of the radial column leads to insufficient functionality and increased capitellar wear. Methods to detect or prevent overlengthening have been described for monopolar prostheses. The aim of this study was to evaluate whether one such method described by Athwal et al. is also applicable for a bipolar prosthesis. MATERIALS AND METHODS: The radial heads of six fresh frozen upper extremities were resected. A bipolar radial head prosthesis was implanted in each, and the effects of sequential overlengthening on the alignment of the radiocapitellar and ulnohumeral joint line were recorded by fluoroscopic images. Digital image analysis and estimation of overlengthening followed according to the method described by Athwal et al. RESULTS: Statistical analysis of the estimated and actual differences between the native state and bipolar replacement of the radial head with stepwise overlengthening of 1.5, 3, 4.5, and 6 mm showed a specificity of 86 % but consistently underestimated the amount of overlengthening with a sensitivity of only 61 %. DISCUSSION: The method described by Athwal et al. for the identification of overlengthening by a monopolar prosthesis was not found to be reliable for ruling out or quantifying overlengthening of the tested bipolar prosthesis. However, the use of the method to detect (rule in) overlengthening may be acceptable in certain circumstances. A reliable method for postoperative quantification of overlengthening by bipolar prostheses has still to be found.

[Locking plate osteosynthesis of the radial head fractures : clinical and radiological results]. / Winkelstabile Plattenosteosynthese des Radiuskopfes : Klinische und radiologische Ergebnisse.

BACKGROUND: Therapy of radial head fractures is still controversially discussed. Especially comminuted fractures are at risk of complications such as radial head necrosis, nonunion and secondary loss of reduction after open reduction and internal fixation. The aim of this study was to evaluate clinical and radiographic results of ORIF (open reduction internal fixation) of radial head fractures using a new radial head-specific locking plate system. PATIENTS AND METHODS: A total of 21 patients (13 men and 8 women) were treated with locking plate osteosynthesis of radial head fractures. Mean age was 50 years (range 29-67 years). According to the Mason classification, 15 were type III and 6 type IV. Mean time between trauma and surgery was 5.6 days (range 0-23 days). These patients were reexamined using the Mayo Elbow Performance Score and x-rays in two planes. RESULTS: In all, 21 patients were reexamined with a mean follow-up of 12.1 months (range 5-23 months). The mean Mayo Elbow Performance Score was 87.1. Excellent results were obtained in 12 patients, good results in 6 patients, and fair results in 3 patients. Mean extension deficit was 12.1°, mean flexion 135.2°, mean pronation 70.9°, and mean supination 63.6°. All fractures healed uneventfully. There was no complete radial head necrosis but one partial. Four cases of heterotopic ossification were detected: Hastings classification I (n = 2), IIb (n = 1), IIIb (n = 1). CONCLUSION: ORIF of radial head fractures using locking plates can lead to good and excellent results. Modern implants may allow for reconstruction of comminuted fractures avoiding arthroplasty in these young patients.

[Mason I fracture - a simple injury?]. / Mason-I-Fraktur - eine harmlose Verletzung?

BACKGROUND: Mason I fractures of the radial head are judged to be simple injuries that can generally be treated nonoperatively. According to the current literature mainly good and excellent results can be expected. We present a case series of patients presenting to us due to complications of Mason I fractures. PATIENTS AND METHODS: We reviewed all cases of patients that were treated because of complaints following Mason I radial head fractures. In all, 16 patients (10 men and 6 women) were identified. Mean age was 37 years (range 16-59 years). Mean time between trauma and surgery was 25 months (range 1-108 months). RESULTS: Ten patients developed painful osteoarthritis with elbow stiffness and loose bodies, 4 patients suffered a posterolateral rotatory instability that had to be treated with ligament reconstruction, 1 patient presented with a combined medial and lateral instability, and 1 patient with a symptomatic hypertophic plica posterolateralis. Diagnotics and therapeutic concepts of these complications will be presented. CONCLUSION: In light of the complications, Mason I fractures must be reevaluated. They remain the domain of conservative treatment but close follow-up is recommended to recognize possible complications early in order to prevent stiffness, chronic instabilities, and osteoarthritis.

The interference of distal humeral plating with the medial and lateral collateral ligaments of the elbow.

INTRODUCTION: The aim of the present study was to determine the anatomical relationship and evaluate the potential interference of today's common distal humerus plates with the medial and lateral collateral ligaments of the elbow. MATERIALS AND METHODS: The elbow joints of 23 embalmed upper extremities were dissected. Three different brands of distal humerus double-plating systems were applied in a standardized fashion. We used a caliper to measure the amount of absolute overlap of the plates on the corresponding collateral ligaments. RESULTS: The data show contact and overlap with the medial and lateral collateral ligaments in all tested medial and lateral plates. The posterolateral and posteromedial plates showed no contact with the ligaments, yet they did contact the posterior joint capsules. The medial plates showed less contact/overlap when compared with the lateral and extended medial plates. CONCLUSION: Based on the present data, we conclude that distal humerus plating using the perpendicular technique with standard-sized medial plates shows the least amount of overlap over the medial and lateral collateral ligaments. The extent of the overlap of the ligaments by the humeral plates is clearly shown in the present study.

Arterial supply of the distal humerus.

PURPOSE: Distal humeral fractures are rare, but severe injuries, the treatment of which is often accompanied by serious complications and its outcome strongly depends on the quality of surgical therapy. Non-union is a common entity, compromising clinical results and requiring revision surgery. Osteonecrosis is an underestimated etiologic factor in the development of non-union. The present study aims to display the distribution patterns of the arterial vessels at the distal humerus, to correlate the displayed vessels with local nutrient foramina and to disclose an endangerment of these structures by common osteosynthetic implants. METHODS: Eight plastinated fresh frozen upper extremities were digitally analyzed regarding the vascular density of the cancellous bone, by calculating the ratio of area comprised by arterial vessels and the area comprised by cancellous bone on sagittal cuts of the distal humerus. Possible differences in the vascular density of the medial epicondylar region, the lateral epicondylar region and a watershed area between the epicondyles and distal to the supracondylar region were investigated. On the basis of 200 macerated humeri, the distribution pattern of cortical nutrient foramina and their anatomic relation to properly applied common distal humerus plates were documented. RESULTS: The data show a significantly higher density of vessels per cancellous bone in the epicondylar regions than in the watershed region (p < 0.000, median 0.148 vs. 0.103). The analysis of the nutrient foramina showed distinct distribution patterns with a single foramen over the medial epicondyle (55 specimens, 27.5 %) and an area of several foramina at the posterior part of the lateral epicondyle (200 of the specimens, 100 %). In almost every specimen, the application of the osteosynthetic implants led to an overlay over the investigated nutrient foramina. DISCUSSION: Osteonecrosis and non-union are severe complications in the surgical treatment of distal humeral fractures. The biology of the bone, especially the blood supply, has to be respected as much as possible during open procedures, to optimize bony healing. This has to be considered when performing periosteal stripping or applying osteosynthetic plates over the postero-lateral and medial epicondyle. The watershed area of the distal humerus has to be considered as being prone to minor arterial blood supply and thereby non-union is possible, if the arterial vessels coming from the epicondyles are destroyed.

[Fracture endoprosthesis of distal humerus fractures]. / Frakturendoprothetik der distalen Humerusfraktur.

The treatment of choice for fractures of the distal humerus is double plate osteosynthesis. Due to anatomical preshaped angle stable plates the primary stability and management of soft tissues has been improved. However, osteoporotic comminuted fractures in the elderly are often not amenable to stable osteosynthesis and total elbow arthroplasty has been established as an alternative therapy. Although complication rates have been reduced, complications of total elbow arthroplasty are still much more frequent than in total hip replacement. Furthermore, patients are advised not to exceed a weight bearing of 5 kg. Therefore, the indications for elbow arthroplasty must be evaluated very strictly and should be reserved for comminuted distal humeral fractures in the elderly with poor bone quality that are not amenable to stable osteosynthesis or for simple fractures in cases of preexisting symptomatic osteoarthritis. This article introduces and discusses modern concepts of elbow arthroplasty, such as modular convertible prosthesis systems, hemiarthroplasty and radial head replacement in total elbow arthroplasty.

[Conversion of elbow arthrodesis to total elbow arthroplasty]. / Konvertierung einer Ellenbogenarthrodese zur Ellenbogenprothese.

A 44-year-old patient was treated with elbow arthrodesis at a position of 90° due to primary osteoarthritis. Seven years later he was introduced to us due to progressive pain of both elbows. Although the arthrodesis had consolidated uneventfully, the patient felt massive restrictions due to eliminated extension/flexion and persistent pain. The right elbow developed primary osteoarthritis likewise. We performed arthroscopic debridement and arthrolysis of the right elbow. After a recovery phase of 2 months we converted the arthrodesis of the left elbow to total elbow arthroplasty. Three months later he achieved active flexion/extension of 0-30-100°, had no pain and was able to perform most activities of daily living again with his left elbow. Movement against resistance was possible, whereas strength was limited compared to the right side. After 9 months the flexion-extension arc was 0-25-110°. This case shows that conversion of arthrodesis to arthroplasty is possible at the elbow. Despite the long arthrodesis period of 7 years the patient was able to activate the elbow extensors and flexors.

[Endoprosthetics of acute radial head fractures]. / Endoprothetik der akuten Radiuskopffraktur.

Radial head arthroplasty is the treatment of choice for non-reconstructble radial head fractures. Solid prostheses made of metal or pyocarbon can restore valgus stability of the elbow independent of design or stem fixation. Short-term and mid-term results show mostly good to excellent results without any evident differences between the different prosthesis philosophies. In order to obtain good results it is important to implant the prosthesis correctly without overfilling and to judge concomitant ligament injuries correctly. This article discusses the anatomical and biomechanical basis of radial head arthroplasty as well as the surgical technique and radiological diagnosis of overfilling.

[Risk of injury to children's fingers in power-operated motor vehicle windows]. / Verletzungsrisiko von Kinderfingern in automatischen Scheibenschliessanlagen von Kraftfahrzeugen.

BACKGROUND: This study examines the dimensions of children's fingers and the risk of jam injuries in a 4-mm gap between glass and gasket of power-operated motor vehicle windows. MATERIAL AND METHODS: The diameter of the proximal, middle, and distal phalanx and of the proximal and distal interphalangeal joint of each finger of the right hand of 160 children was measured in a cross-sectional investigation. Six different drawings in cross section of gaskets and glass window panes of current motor vehicle side door windows at a vertical gap of 4 mm were drawn in correct proportion. The larger actual width of the oblique gap between window glass and gasket was measured and related to the diameters of children's fingers. RESULTS: Almost all fingers and joints fit in the largest actual gap of 18 mm between glass and gasket of one seal design. CONCLUSION: The European guideline 74/60/EWG specifications currently pertaining to closing force restriction do not eliminate the risk of potentially serious injury to children's fingers in motor vehicle power windows.

The durability of the intrascaphoid compression of headless compression screws: in vitro study.

PURPOSE: To test a new generation of compression screws: the Acumed Acutrak 2 Mini (AA; Acumed, Hillsboro, OR), the Stryker TwinFix (ST; Stryker, Kalamazoo, MI), and the Synthes 3.0 headless compression screw (SH; Synthes, Solothurn, Switzerland). METHODS: We used 40 fresh-frozen human scaphoids for this study. Bone density was measured. A K-wire was inserted centrally. A perpendicular osteotomy was created in the middle third (Herbert B2 fracture). A custom-made load sensor was placed between the bone fragments. All screws were implanted according to the manufacturers' instructions. The Synthes 2.0 cortical screw (SC), implanted as a lag screw, was used as a reference. The compression force during each experiment was digitally monitored for 12 hours while the data were acquired. The data were analyzed using analysis of variance with the Bonferroni correction. RESULTS: Immediately after screw insertion, ST reached 226 N, followed by AA with 191 N, SH with 137 N, and SC with 72 N. After 12 hours, ST displayed the highest residual compression force, 141 N, followed by AA with 121 N, SH with 78 N, and SC with 32 N. The differences were significant for ST and AA compared to SC. The loss of compression force over 12 hours was 39% for ST, 42% for AA, 49% for SH, and 55% for SC. CONCLUSIONS: The new generation of headless compression screws, especially ST and AA, provided significantly higher compression forces after 12 hours, as well as the least loss of compression force over time, in comparison to a classic cortical lag screw. CLINICAL RELEVANCE: A new generation of headless compression screws, by producing higher compression forces, increase stability at the fracture site and might thereby promote bone healing.

[Coronoid reconstruction with autologous iliac crest bone graft in chronic elbow instability through a medial approach]. / Coronoidaufbau mittels Beckenkammspan über einen medialen Zugang zur Therapie von chronischen Coronoiddefekten mit posteromedialer Rotationsinstabilität.

OBJECTIVE: Neutralizing a posteromedial rotatory instability (PMRI) caused by coronoid deficiency by restoration of the humeroulnar joint surface with an autologous iliac crest bone graft. INDICATIONS: Surgery is indicated in patients with chronic deficiency of the anteromedial facet of the coronoid with subsequent PMRI. CONTRAINDICATIONS: Coronoid reconstruction is not recommended in patients with advanced osteoarthritis of the elbow caused by subluxation of the humeroulnar joint. General contraindications like acute infection, pregnancy and lack of operability should also be taken into account. SURGICAL TECHNIQUE: First, a medial approach is established and the base of the coronoid is prepared. Afterwards an autologous iliac crest bone graft is placed onto the defect and secured by screws or a plate. In addition, a reconstruction of the anterior bundle of the medial collateral ligament with an autologous tendon graft is performed. POSTOPERATIVE MANAGEMENT: An elbow orthesis is worn for 6 weeks after surgery to avoid valgus or varus stress. There is no restriction in range of motion. A continuous passive motion elbow chair supports the patient in regaining elbow mobility. RESULTS: Between 2015 and 2017, we treated 10 patients suffering from chronic coronoid defects with coronoid reconstruction. Eight of the patients were available for follow-up 86 weeks after surgery. The mean age was 41.4 years. In all patients, elbow range of motion and patient-related outcome measures were improved after surgery. Plain radiographs illustrated correct centering of the elbow joint. One patient had to undergo elbow arthroplasty and was excluded. Coronoid reconstruction with an autologous iliac crest bone graft restored humeroulnar joint congruency and improved satisfaction in patients suffering from chronic coronoid deficiency.