Surgical treatment of coronal shear fractures: short- to mid-term results and risk factor analysis

Surgical treatment of coronal shear fractures: short- to mid-term results and risk factor analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Surgical treatment of coronal shear fractures: short- to mid-term results and risk factor analysis Anne Bauer, Luise Cornel, Matthias Sauter, Tim Jakobi, Matthias Münzberg, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8359569/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Apr, 2026 Read the published version in European Journal of Trauma and Emergency Surgery → Version 1 posted 9 You are reading this latest preprint version Abstract Background Coronal shear fractures of the distal humerus are rare but severe injuries. Reconstruction is often challenging, especially in comminuted and multifragmentary cases, which is why many surgeons opt for an elbow replacement in those cases. However, total elbow arthroplasty is associated with a variety of potential problems itself. Therefore, the aim of this study was to present the functional and clinical outcome of coronal shear fractures treated by osteosynthetic reconstruction in a short- to mid-term follow up, and to identify possible risk factors for an inferior outcome. Methods We performed a retrospective follow-up assessment of 51 consecutive patients (30 women and 21 men; mean age, 52,2 years (range 18–78)) who underwent osteosynthetic reconstruction for coronal shear fractures between 2012 und 2022 after a minimum follow-up period of 2 years. The Mayo Elbow Performance Score, Oxford Elbow Score, and Disabilities of the Arm, Shoulder and Hand Score, were evaluated, and all available radiographs were analyzed. All complications and revision procedures were assessed. Bivariate and multivariate regression analyses were performed to identify potential risk factors for a poor outcome following osteosynthetic reconstruction. Results After an average follow-up period of 49 months (range, 24–134 months), the mean Mayo Elbow Performance Score was 90,0 (range, 40–100), the mean Oxford Elbow Score 38,4 (range, 18–48), and mean Disabilities of the Arm, Shoulder and Hand Score 16,7 (range, 0–69). The average range of motion was 136° (range, 100–140°) for flexion, 0° (range, -10-10) for extension, 87° (range, 60–90°) for pronation, and 85° (range, 10–90°) for supination. There was no extension deficit on the injured site. The overall complication and reoperation rates were 35.3% and 27.4%, respectively, with severe elbow stiffness being the most common reason for revision. Increasing Dubberley classification and posterior comminution were significantly associated with a poor outcome and higher rates of complications and revision. Conclusion This short- to mid-term follow up shows good functional results after osteosynthetic reconstruction in coronal shear fractures despite high complication and revision rates. However, increasing Dubberley classification, posterior comminution and the presence of complications show inferior outcome scores. This study shows that osteosynthetic reconstruction can be an option even in comminuted coronal shear fractures. Nevertheless, patient factors need to be considered and an individual decision concerning the surgical treatment is necessary. Patients should be counseled about the high complication rates and inferior outcome with increasing Dubberley classification. Level of Evidence Level III Coronal shear fractures functional results short- to mid-term follow up osteosynthetic reconstruction Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Coronal shear fractures are rare injuries and account for about 1% of all elbow fractures and up to 6% of all distal humerus fractures [62]. More than 80% of the fractures occur in elderly people, especially females, due to lower bone density, increased cubitus valgus or recurvatum [21,36,37,46,49]. In younger patients, high-energy trauma mechanisms are more common. The injury typically occurs after a low-energy fall onto an outstretched hand and hyperextended or semi flexed elbow. The axial force is transduced through the radial head and produces a coronal plane line fracture. Additionally, a posterolateral elbow dislocation or subluxation can also lead to a coronal shear fracture, when the radial head shears off the capitulum during reposition of the joint [ 17 ]. These two mechanisms can also explain the high incidence of concomitant injuries. While half of the coronal shear fractures occur in isolation, up to 50% are associated with concomitant injuries such as radial head fractures, rupture of the lateral collateral ligament and coronoid fracture [1,12,26,44]. Open reduction and internal fixation (ORIF) is the recommended treatment in the current management of coronal shear fractures to achieve stable anatomic reduction, restore articular congruity and initiate early motion [ 29 ]. However, the fixation of these fractures is often very challenging, due to multiple, small fragments which do not allow stable fixation. Therefore, coronal shear fractures, especially higher degree, are often associated with poor functional outcome. Complications such as restriction of ROM, irritation of the ulnaris nerve, hardware complications, heterotopic ossifications or osteoarthritis can occur [1,12,26,44]. Therefore, there is an ongoing discussion in the literature whether an open fixation or a primary replacement should be performed, especially in elderly patients. However, the risks of a primary replacement such as loosening and life-long weight limitation also need to be considered. Due to its rare nature as well as a high individual heterogeneity in previous study groups, valid data on coronal shear fractures is rare. Even though there are a few short-term results, there are almost no mid-to long- term studies currently available. Therefore, the aim of this study was to evaluate the functional and clinical outcome after primary reconstruction of coronal shear fractures in a short- to mid-term follow-up and to identify potential risk factors for a poor outcome. Methods Study design This was a retrospective case series performed at a single level I trauma center. The patients were identified by searching the clinic’s patient management system (Medico; Cerner Health Services, Idstein, Germany) from 2012 to 2022 for all coronal shear fractures using ICD code S 42.49 (International classification of diseases, 10th edition) with a follow-up period of at least 2 years. In addition, patients were only eligible for inclusion if they were aged > 18 years and had not undergone previous surgical procedures or sustained prior injuries to the affected elbow (Fig. 1 ). All fractures were classified according to the Dubberley classification system using preoperative CT scans [ 10 ]. Mostly fractures were type 1B and 3B fractures followed by 1A fractures. For detailed classification see Fig. 2 . Surgical approach and treatment We developed an algorithm that was used for treatment choice (Fig. 3 ). When ORIF was performed, the lateral approach through the Kocher interval was primarily used. Proceeding through the subcutaneous tissues and dissection of the anterior capsule, the distal humerus was exposed. If the fracture extended to the medial side and in all Dubberley 3 fractures, an additional medial approach was used (n = 18). Reduction was performed and the fragments were temporarily stabilized with K-wires. The main goal was to obtain anatomic reduction and to restore the congruity of the joint surface as well as to achieve a stable reconstruction. Definitive fixation was obtained through cannulated headless compression screws (Medartis, Basel, Switzerland). In fractures with posterior comminution, an additional precontoured locking plate from dorsolateral (VA-LCP distal humeral plate, DePuy Synthes, Zuchwil, Solothurn, Switzerland) was administered through the Kocher approach, working as a template for distal humerus inclination as well as to increase stability and to reduce forces on the single screws. The lateral collateral ligament, when injured, was reinserted to its humeral origin using transosseous sutures or screw anchors. Postoperatively, the elbow was splinted in a cast at 90° of flexion for one week, following an early active motion protocol using a dynamic splint for additional 5 weeks. All patients were instructed to perform range-of-motion (ROM) exercises without wearing the brace to minimize joint stiffness while maintaining stability. If the patients hat no contraindication, they received oral nonsteroidal anti-inflammatory medication for 2 weeks as ossification prophylaxis. Outcome measures After a minimum follow-up period of 2 years, the patients were invited to undergo a clinical evaluation by an independent investigator. The range of motion (ROM) of both elbow joints was tested using a standard goniometer, and ligamentous stability was measured using valgus and varus stress tests. Elbow stiffness was rated according to the degree of the residual arc of motion. Functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), and the German version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) [ 4 , 9 , 24 ]. All available radiographs were evaluated by 2 independent investigators (A.K and L.C.). Radiographic signs of osteoarthritis (OA) were rated according to the Broberg-Morrey classification (mild, moderate and severe) [ 6 , 19 ]. Heterotopic ossification (HO) was graded using the system of Hastings and Graham [ 13 ]. A Jamar dynamometer (Fabrication Enterprises, White Plains, NY, USA) was used to assess grip strength compared with the uninjured side, with the application of a correction factor of 1.07 for the dominant hand over the nondominant hand [ 34 ]. Complications were defined as adverse events directly related to the surgical treatment, including persistent elbow stiffness (defined as ROM < 60° in extension-flexion at 6 months following initial procedure), ulnar nerve injury, hardware failure and non-union. Revision was defined as any subsequent surgical intervention related to the index procedure. Statistical analysis Statistical analysis was conducted using IBM SPSS Statistics software (version 25; IBM Germany, Ehningen, Germany). The Chi 2 test was used to determine statistical differences in categorical data such as complication rate, reoperation rate, HO, and OA. Mean values were compared using the Mann-Whitney U test for nonparametric variables. In addition, bivariate regression analyses were performed to determine which demographic and clinical variables were independently predictive of a poor outcome (defined as MEPS < 70 points). Predictors used in the bivariate model included those that were statistically significant on bivariate analysis and those generally accepted in the literature to be potential confounders. P values were reported. Correlations between these variables were analyzed using the F coefficient (Pearson correlation coefficient for binary variables) and its associated P value. P < .05 was considered significant. Results Clinical and functional results Patient demographic characteristics are detailed in Table I. The average follow-up period was 49 months (range, 7-135 months). At final follow-up, the average range of motion was 136° (range, 100–140) for flexion, 0° (range, -10-10) for extension, 87° (range, 60–90°) for pronation, and 85° (range, 10–90°) for supination, both of which differed significantly compared with the unaffected side (P < .001). There was no extension deficit on the injured site. At the final visit, the mean MEPS was 90,0 (range, 40–100), the mean OES was 38,4 (range, 18–48), and the mean DASH Score was 16,7 (range, 0–69). Mean grip strength measured 92.9% (range, 53,4-144%) compared with the uninjured arm, with approximately one third of the patients regaining full grip strength compared to the uninjured side. Table 1 demographic results characteristics data Population, n Female % (n) Male % (n) 51 58,8 (30) 41,2 (21) Mean follow up (range), months 49 (24–135) Mean age at surgery (range), yr 52,2 (18–78) patients age 70 years, % (n) 88,2 (45) 11,8 (6) dominant site injured % (n) non dominant site injured %(n) 39,2 (20) 60,8 (31) Mean BMI (range), kg/m 2 BMI 25, % (n) 25,5 (17,0–42,0) 62,7 (32) 37,3 (19) Open fracture, % (n) 3,9 (2) Mean time to surgery, days (range) 5,8 (0–20) Mean surgery time, min (range) 125,2 (39–313) Radiographic outcome There were no signs of hardware failure. All patients showed fracture union at follow up. Avascular necrosis occurred in 1 patient. This patient did not show any functional or clinical restrictions, no further intervention was needed. According to the Broberg and Morrey classification system, signs of osteoarthritis were observed in 23 of 51 patients (45,1%). Mild osteoarthritis occurred in 14 patients, moderate osteoarthritis in 7 patients and severe osteoarthritis in 2 patients (humeroulnar 65,2% (n = 15), radiocapitellar 34,8% (n = 8)). Compared to the patients without osteoarthritis, the MEPS and DASH Score showed an inferior outcome in the osteoarthritis group although not statistically significant (p = 0,211 und p = 0,242). The extension and flexion were significantly worse in patients with signs of osteoarthritis (p = 0,038), whereas the pro- and supination was not impaired (p = 0,887). Osteoarthritis had the tendency to occur more often in Dubberley type B fractures without statistical significance (p = 0,276). Heterotopic ossifications occurred in 12 of 51 patients (23,5%), mainly stage 1 (9 patients), 2 stage 2A and 1 stage 3, but there was no inferior outcome in the patients showing signs of heterotopic ossifications. Complications All complications and revisions are summarized in Fig. 4 . 35,3% of our patients (n = 19) experienced complications during follow-up, and 14 patients (27,4%) required additional surgical treatment during follow-up. Most of the complications were due to ongoing severe joint stiffness (n = 11) and hardware irritation of a dorsal plate (n = 5). In these cases, surgical arthrolysis and removal of the hardware was performed. No patient with reconstruction required the implantation of a secondary prosthesis. 86,6% of the complications occurred in Dubberley type B fractures (P = 0,001), although, the functional results were still good (MEPS 89,0, DASH 19,1, OES 37,5). Risk factors for a poor outcome The variables that were tested against a poor outcome (MEPS < 70 points) after osteosynthesis are summarized in Table 2 , which have previously been described in the literature. Age was dichotomized (70 years) for regression analysis. Univariate regression analysis was performed for increasing Dubberley classification, posterior comminution, and injury of the dominant site were significantly associated with a poor outcome. Surprisingly, age and BMI did not show any significant differences between these groups (Table 2 ). Intervariable correlations could be detected for increasing Dubberley classification and Dubberley type B fracture (Table 3 ). Table 2 results of univariant regression analysis Risk factors p-value Odds Ratio 95% KI Age > 70 y 0,390 0,87 0,78 − 0,97 Female sex 0,311 3,08 0,32 − 29,71 Dubberley type 2,3 or 4 0,003 1,22 1,02 − 1,45 Dubberley type B 0,002 1,75 1,50 − 1,92 Dominant site 0,003 0,75 0,58 − 0,97 Osteoarthritis 0,481 0,58 0,08 − 3,37 BMI > 25 0,894 1,14 0,17 − 7,50 Fracture of the radial head 0,739 1,12 1,01–1,22 Extensor rupture 0,561 1,11 1,01–1,22 MCL rupture 0,768 1,08 1,00–1,18 LCL rupture 0,754 1,07 1,01–1,23 Occurance of complications/revisions 0,373 0,67 0,45 − 0,98 BMI = Body mass index; MCL: medial collateral ligament; LCL: lateral collateral ligament; bold = statistically significant Table 3 results of multivariate regression analysis Risk factor p-value Regression coeffizient Dubberley type 2,3,4 0,004 0,272 Dubberley type B 0,003 0,341 Dominant site 0,149 -0,186 Overall Regression R 2 0,521 0,271 bold = statistically significant Discussion Coronal shear fractures are rare injuries and account for about 6% of all elbow fractures. Due to their demographic correlations, they are usually associated with low bone density, and multifragmentary fractures. Initial treatments range from conservative to open reduction and internal refixation (ORIF) to total elbow arthroplasty (TEA), however there is no consensus about choosing the right treatment according to the fracture type and patient [ 29 ]. ORIF is mostly recommended when stable fixation is possible allowing anatomic reconstruction and early motion. However, the presence of comminution and low bone density makes it a difficult procedure in the elderly patient. For this reason, elbow arthroplasty has been an alternative surgical option, especially in elderly patients [ 12 , 25 , 30 ]. Still, due to the plethora of complications associated with TEA, like loosening and weight restriction, there is an ongoing debate, which patients are best treated with osteosynthetic reconstruction. In this study, we present the short- to mid-term outcomes of the largest single-center cohort of patients with coronal shear fracture which were all treated with ORIF. For standardized treatment, widely used classification systems and treatment algorithms are required to ensure valid treatment. Watson et al. implemented the Modified Dubberley Classification System by adding a forth type (multiple fragment in multiple planes) to the already known Dubberley classification [ 37 ]. For type A fractures they suggest screw fixation as well as an antiglide plate if needed. For type 1B and 2B fractures posterolateral plating as well as bone grafting can be used. In type 3B and 4B fractures they suggest using additional medial plating or arthroplasty. Using this system to classify the fractures preoperatively, Shergold et al. and Mukohara et al. showed good functional outcomes despite the fracture type [ 25 , 30 ]. The worse outcomes with increasing Dubberley classification confirm the Dubberley classification as a good prognosis prediction tool [ 25 ]. In our opinion, despite the fracture classification, patient factors are similarly relevant for treatment decision and should be also considered. We additionally present a treatment algorithm to simplify the decision which treatment should be used [ 3 ]. As shown, we suggest, if stable fixation is achievable, despite a comminuted fracture pattern, to use ORIF as the surgical treatment. However, if certain risk factors are present and stable fixation is not possible, we recommend either hemi or total elbow arthroplasty. We want to point out that this treatment algorithm is intended as an orientation, and an individual decision is often necessary concerning the factors mentioned before. In the overall population the functional outcome in our cohort was good with MEPS, DASH and OES all showing good to excellent results. These results are comparable with the scores from a prior case series. Lopiz et al. reported an average MEPS of 92,2 at similar follow up after ORIF, Mukohara et al. reported 96,3 at only 15 months of follow up [ 20 , 25 ]. Hulet et al. reported still excellent results with an average MEPS score of 94,9 at the longest follow up found in the literature with 76 months [ 14 ]. Therefore, our study adds to the good functional outcomes after ORIF reported in other studies which underlines the necessity of a successful osteosynthesis (Table 4 ). However, we reported high rates of complications (35,3%) and reoperations (27,4%), which could be related to our definition of a complication, as we also included elbow stiffness, which is a common finding after a complex elbow fracture [ 12 , 20 , 25 , 30 ]. Likewise, it remains unclear, how other authors define “complication”, with some of them including radiographic findings, while others only consider clinical complications or reoperations [ 12 , 20 ]. If ulnar nerve parasthesia, nonunion or loss of reduction, and restriction of ROM are considered reoperation rates are reported to be as high as 50% [ 7 , 11 , 23 , 28 , 29 ]. The high complication rate observed in our study could also be attributed to significant portion of complex injuries (type B 70,6%). However, it is also important to mention that despite the occurrence of a follow-up complication, patients still achieved good overall functional results. Nevertheless, patients must be informed preoperatively about high complication rates and the different treatment types. Despite treating a high number of complex cases (Dubberly 3/B, n = 18) nonunion did not occur. We explain that by good anatomic reduction and reconstruction of the lateral and medial columns which contributes to enhance the blood supply and therefore fracture healing [ 15 , 17 , 36 ]. Degenerative changes were seen in 45,1%, however these were mainly mild. These findings are similar to the current literature, with osteoarthritic signs being reported in up to 40% of the cases [ 20 , 21 , 30 , 32 , 33 , 38 ]. Osteoarthritis in elbow fractures is complex and multifactorial. However, occult cartilage damage caused by the initial trauma and persistent instability seem to be important factors [ 8 ]. Therefore, it is rather obvious that osteoarthritis is more frequently seen in type B fractures. However, the presence of osteoarthritis changes did not impact the functional outcome despite lower ROM, the patients´ daily activities were not impaired in our study. Consequently, no secondary procedures were required. Lopiz et al. reported mild osteoarthritis in 15%, however they found significantly lower functional scores compared to patients with no osteoarthritic signs (MEPS 70/96, p = 0,05) [ 20 ]. Nevertheless, this complication requires longer term evaluation since osteoarthritic changes can worsen and further treatment might be necessary leading to further treatment or surgery. Heterotopic ossifications were seen in 23,5%, mostly in type B fractures. As reported in the literature, heterotopic ossifications occur in 0–47% of all cases but are mostly low grade and asymptomatic. They are associated with increasing Dubberley classification and therefore posterior comminution, extended approaches can lead to heterotopic ossifications [ 12 , 20 , 23 , 25 , 27 , 30 , 31 , 33 , 36 , 38 ]. Nevertheless, heterotopic ossifications were mainly asymptomatic and did not require further surgery in our study. The most important factor for a poor postoperative outcome in our study was the degree of comminution. These findings are consistent with the findings in other studies, where average arc reduction of 25° was reported when comparing type 3 to type 1 fractures [ 32 ]. Ruchelsman et al. as well as McKee et al. both reported decreased arc of motion and lower MEPS when comparing type 3 or 4 with type 1 fractures [ 22 , 29 ]. Increasing Dubberley classification often accompanies increased severity of the articular injury, the presence of concomitant injuries such as radial head fractures, and the extended surgical dissection that is needed to facilitate exposure and visibility of the anterior articular fragments [ 29 , 32 ] Despite the need for counseling patients about the possibility of developing flexion contractures and lower range of motion compared to the healthy site, a functional range of motion is still achievable as our results and aforementioned studies suggest [ 15 , 22 , 29 ]. In addition to the factors mentioned before, posterior comminution was also associated with a poor functional outcome in our study. These findings are consistent to the studies by Ashwood et al and Durakbasa et al. [ 1 , 12 ]. If posterior comminution is present, further plating is often required to restore the humeral offset and adequate joint congruity [ 36 , 37 ]. In addition, persistent instability that comes with posterior comminution can also lead to flexion-extension contractures and lower functional outcome and patients´ satisfaction. An additional plate and further fixation are required to buttress the humeral comminution, to restore humeral offset and to gain adequate purchase and stability [ 35 , 36 ]. This may allow stable fixation and early range of motion [ 4 ]. Despite optimal surgical treatment, patients with comminuted fractures are still at high risk to have lower functional results and range of motion [ 22 , 29 , 32 ]. In our cohort no conversion into a secondary elbow arthroplasty was performed. Durakbasa et al., Shergold et al. and Mukohara et al. all recommend using ORIF in (mainly young) patients to restore articular congruity. In elderly people, total elbow arthroplasty could be an option if stable fixation is not possible. Shergold et al. reported more severe complications in ORIF than in TEA, Mukohara et al. reported a lower MEPS in multifragmentary fractures when severe fractures were treated with ORIF compared to TEA [ 12 , 25 , 30 ]. However, Tomori et al. recently reported good functional results and little complications with ORIF in noncomminuted fractures in a small study including only elderly patients (n = 8; average age 76,3 years) [ 35 ]. Based on our algorithm, a reconstruction is performed as long as a stable fixation can be achieved, independently of age. If stable fixation is not possible, individual patient factors such as age, comorbidities as well as patient´s demand should be considered [ 20 , 21 , 23 , 29 , 32 , 38 ]. In this context, Dirckx et al. compared hemiarthroplasty to ORIF at 34 months of follow up in multi fragmentary intraarticular distal humeral fractures. They showed comparable complication rates in hemiarthroplasty and ORIF, when an adequate fixation technique was used, concluding that ORIF might also be the preferrable option for selected elderly patients [ 10 ]. Elbow arthroplasty can be an option in elderly patients with poor subchondral bone stock or in complex comminuted fractures when stable anatomic fixation cannot be achieved. However, primary arthroplasty as fracture treatment should be chosen wisely concerning severe complications such as loosening, revision arthroplasty and infection. This study has some limitations. First, this was a retrospective, single-center study, which is inherently prone to bias (e.g., performance differences between the attending surgeons) and loss to follow-up. Second, the size of the total cohort and the number of patients in certain subgroups were rather small, limiting the ability to draw conclusions or to yield a more precise prediction model. However, this is the largest case series describing the functional outcomes of treatment of coronal shear fractures in the current literature. The short- to mid-term follow-up can lead to falsely low rates of long-term complications such as post-traumatic arthritis. However, a review of the literature indicates that a follow-up period of 3 years is considered sufficient for the assessment of stability, function, and most surgical complications in treatment studies [ 16 ]. Table 4 Functional results and overall complication rate after surgical treatment of coronal shear fractures Author FU N Function Flex-ext Pro-Sup OC RO Hulet et al. 2023 [ 20 ] 76,6 18 DASH 6,8 (0–25) 137° (130–145°) 4° (0–30°) 164° 38,9% (7) 0 Shergold et al. 2022 [ 21 ] 28 45 n. s. 130° (110–140°) 10° (0–50°) 170 (140–180) 26,7% (12) 33,3% (15) Tomori et al. 2022 [ 22 ] 23,6 8 MEPI 78,8 (70–100) n.s. n.s. 100% (8) Yoshida et al. 2021 [ 23 ] 23,5 16 MEPI 83,8 (60–100) n.s. n.s. 6,25% (1) Mukohara et al. 2021 [ 24 ] 15 25 MEPI 96,3 (70–100) 130° (100–145°) 10° (-5-30°) n.s. 56,0% (14) Tarallo et al. 2021 [ 25 ] 30 24 MEPI 92,1 (72,5-100) Broberg 90,7 (72–99,5) n.s. complete 16,7% (4) 12,5% (3) Teng und Zhong 2020 [ 26 ] 17 19 MEPI 85,8 (70–100) n.s. 167,4° (155–175°) 21,0% (4) Song et al. 2020 [ 27 ] 17,6 52 MEPI 90,6 (60–100) 136° (90–150°) 3° (0–15°) 180° 15,4% (8) Wang et al. 2019 [ 28 ] 32,5 15 MEPI 89 (70–95) DASH 11,2 (4,2–20,8) 123,7° (110–135°) 11° (5–30°) 160,5° (140–180°) 26,7% (4) Tanwar et al. 2018 [ 29 ] 10 DASH 24 (14,2–35,8) n.s. n.s. 20,0% (2) Marinelli et al. 2018 [ 30 ] 40 45 MEPI 78 (60–100) n.s. n.s. 51,1% (23) Lopiz et al. 2016 [ 31 ] 48 23 MEPI 92,7 (60–100) DASH 9,8 (0–75) 122° (100–135°) 8° (0–30°) 167° (90–180°) 55,0% (11) Ravishankar et al. 2016 [ 32 ] 24,6 33 MEPI 80,9 n.s. 151° 27,3% (9) Tarallo et al. 2015 [ 33 ] 30 8 MEPI 92 (78–100) 125° (100–140°) 20° (10–40°) 141,5° (130–150°) 37,5% (3) Durakbasa et al. 2013 [ 7 ] 50 15 MEPI 83,3 (60–100) n.s. n.s. 53,3% (8) Ashwood et al. 2010 [ 11 ] 46 26 MEPI 81,3 (65–100) 128,8° (119,5-134°) 14,1° (7,5–20,5°) 108,9° (83–132°) 30,8% (8) 23,1% (6) Mighell et al. 2010 [ 3 ] 26 18 ASES 83,1 (21,3-100) Broberg 93,3 (57–100) n.s. 176° (120–180°) 50,0% (9) 0 Ruchelsmann et al. 2008 [ 5 ] 27 16 MEPI 91,6 (65–100) 133° (100°–150°) 10° (0°–45°) 180° 75,0% (12) 6,2% (1) Dubberley et al. 2006 [ 9 ] 56 28 MEPI 91 (65–100) 138° (129,3-144,8°) 19 (1–35°) 156° 60,7% (17) 42,8% (12) FU = Follow-Up; OC = overall complications; RO = reoperations; n.s.= not specified Conclusion Satisfactory short- to mid-term functional outcomes can be achieved using osteosynthetic reconstruction in patients with acute coronal shear fractures. However, complication and revision rates are substantial, frequently leading to inferior outcome scores. Additionally, a higher grade of Dubberley classification, as well as the presence of posterior comminution were associated with a poor outcome; in contrast, a higher age and BMI did not show any differences in outcome. These factors should raise awareness by the trauma surgeon choosing the surgical treatment. Declarations Funding The authors did not receive support from any organization for the submitted work. No funding was received for conducting this study. Competing interest All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Ethics Approval All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee of Landesärztekammer Hessen (2020-2100-evBO). There are no ethical or legal concerns regarding this study. Informed consent Written informed consent was obtained from all subjects before the study. Patients signed informed consent regarding publishing their data and photographs. Data Research data was generated in this study. All data supporting the findings of this study are available within the paper. Authors contribution A.B. wrote the main manuscript text including figures and table. L.C. collected data and reviewed the manuscript. M.S. reviewed the manuscript and contributed to the treatment algorithm. T.J. reviewed the manuscript and reviewed the data. 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Imatani J, Morito Y, Hashizume H, Inoue H. Internal fixation for coronal shear fracture of the distal end of the humerus by the anterolateral approach. J Shoulder Elb Surg. 2001;10(6):554–6. 10.1067/mse.2001.118005 . Laumonerie P, Reina N, Kerezoudis P, Declaux S, Tibbo ME, Bonnevialle N, et al. The minimum follow-up required for radial head arthroplasty. Bone Joint J. 2017;99–B(12):1561–70. 10.1302/0301-620X.99B12.BJJ-2017-0543.R2 . Lee JJ, Lawton JN. Coronal shear fractures of the distal humerus. J Hand Surg. 2012;37(11):2412–7. 10.1016/j.jhsa.2012.09.001 . Lee SK, Kim KJ, Park KH, Choy WS. A comparison between orthogonal and parallel plating methods for distal humerus fractures: a prospective randomized trial. Eur J Orthop Surg Traumatol. 2014;24(7):1123–31. 10.1007/s00590-013-1286-y . Lindenhovius A, Karanicolas PJ, Bhandari M, Ring D. Radiographic arthrosis after elbow trauma: interobserver reliability. J Hand Surg. 2012;37(4):755–9. 10.1016/j.jhsa.2011.12.043 . Lopiz Y, Rodríguez-González A, García-Fernández C, Marco F. Open reduction and internal fixation of coronal fractures of the capitellum in patients older than 65 years. J Shoulder Elb Surg. 2016;25(3):369–75. 10.1016/j.jse.2015.12.004 . Marinelli A, Cavallo M, Guerra E, Ritali A, Bettelli G, Rotini R. Does the presence of posterior comminution modify the treatment and prognosis in capitellar and trochlear fractures? Study performed on 45 consecutive patients. Injury. 2018;49(Suppl 3):S84–93. 10.1016/j.injury.2018.09.060 . McKEE MD, Jupiter JB. Coronal Shear Fractures of the Distal End of the Humerus*. J Bone Jpint Surg. 1996;78(1):49. Mighell M, Virani NA, Shannon R, Echols EL, Badman BL, Keating CJ. Large coronal shear fractures of the capitellum and trochlea treated with headless compression screws. J Shoulder Elb Surg. 2010;19(1):38–45. 10.1016/j.jse.2009.05.012 . Morrey B. The elbow and its disorders. 4th ed. Elsevier Health Sciences; 2009. (ISBN No. 9781416029021). Mukohara S, Mifune Y, inui A, Nishimoto H, Kurosawa T, Yamaura K, et al. Effects of trochlear fragmentation on functional outcome in coronal shear fractures: a retrospective comparative study. J Shoulder Elb Surg Int. 2021;5(3):571–7. 10.1016/j.jseint.2020.12.011 . Niglis L, Bonnomet F, Schenck B, Brinkert D, Di Marco A, Adam P, et al. Critical analysis of olecranon fracture management by pre-contoured locking plates. Orthop Traumatolog Surg Res. 2015;101(2):201–7. 10.1016/j.otsr.2014.09.025 . Ravishankar MR, Kumar MN, Raut R. Choice of surgical approach for capitellar fractures based on pathoanatomy of fractures: outcomes of surgical management. Eur J Orthop Surg Traumatol. 2017;27(2):233–42. 10.1007/s00590-016-1877-5 . Ring D, Jupiter JB, Gulotta L. Articular Fractures of the Distal Part of the Humerus. JBJS. 2003;85(2):232. Ruchelsman DE, Tejwani NC, Kwon YW, Egol KA. Open reduction and internal fixation of capitellar fractures with headless screws. J Bone Joint Surg Am. 2008;90(6):1321–9. 10.2106/JBJS.G.00940 . Shergold S, Derias M, Moverley R, Murphy RJ, Guryel E, Phadnis J. Coronal shear fractures of the distal humerus managed according to the Modified Dubberley Classification System. J Shoulder Elb Surg. 2022;31(1):133–42. 10.1016/j.jse.2021.07.002 . Tang H-C, Xiang M, Chen H, Hu X-C, Yang S, Yang G-Y. Cannulated screw combined with buttress plate for the treatment of transarticular shear fractures of the distal humerus. Zhongguo Gu Shang. 2014;27(2):161–4. Tarallo L, Novi M, Porcellini G, Giorgini A, Micheloni G, Catani F. Surgical tips and tricks for coronal shear fractures of the elbow. Arch Orthop Trauma Surg. 2021;141(2):261–70. 10.1007/s00402-020-03500-9 . Teng L, Zhong G. Surgical Treatment of Comminuted Coronal Shear Fracture of Distal Humerus. Orthop Surg. 2020;12(5):1439–47. 10.1111/os.12765 . Thorngren K-G, Werner CO. Normal Grip Strength Acta Orthop. 1979;50(3):255–9. 10.3109/17453677908989765 . Tomori Y, Nanno M, Sonoki K, Majima T. Surgical Outcomes of Coronal Shear Fracture of the Distal Humerus in Elderly Adults. J Nippon Med Sch. 2022;89(1):81–7. 10.1272/jnms.JNMS.2022_89-202 . Wang P, Kandemir U, Zhang K, Zhang B, Song Z, Huang H, et al. Treatment of capitellar and trochlear fractures with posterior comminution: minimum 2-year follow-up. J Shoulder Elb Surg. 2019;28(5):931–8. 10.1016/j.jse.2018.09.004 . Watson JJ, Bellringer S, Phadnis J. Coronal shear fractures of the distal humerus: Current concepts and surgical techniques. Shoulder Elb. 2020;12(2):124–35. 10.1177/1758573219826529 . Yoshida S, Sakai K, Nakama K, Matsuura M, Okazaki S, Jimbo K, et al. Treatment of Capitellum and Trochlea Fractures Using Headless Compression Screws and a Combination of Dorsolateral Locking Plates. Cureus. 2021;13(3):e13740. 10.7759/cureus.13740 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 30 Apr, 2026 Read the published version in European Journal of Trauma and Emergency Surgery → Version 1 posted Editorial decision: Revision requested 13 Feb, 2026 Reviews received at journal 12 Feb, 2026 Reviewers agreed at journal 12 Feb, 2026 Reviews received at journal 23 Dec, 2025 Reviewers agreed at journal 23 Dec, 2025 Reviewers invited by journal 23 Dec, 2025 Editor assigned by journal 22 Dec, 2025 Submission checks completed at journal 20 Dec, 2025 First submitted to journal 14 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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08:49:23","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":139694,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8359569/v1/8e81071184c73d4463c43886.html"},{"id":99214458,"identity":"1e42cacf-98f4-41c8-970c-6a20a3a6f6be","added_by":"auto","created_at":"2025-12-30 08:49:23","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":144321,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart showing selection of patients\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8359569/v1/95f7718bdd9dbaf9c4ff3ba0.jpeg"},{"id":99318201,"identity":"ad37e99e-dade-4a7f-ad83-e48c12f7b82b","added_by":"auto","created_at":"2025-12-31 16:31:59","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":362416,"visible":true,"origin":"","legend":"\u003cp\u003eDubberley classification Type 1 isolated capitellum, type 2 trochlea and capitellum (single fragment), type 3 trochlea and capitellum (separate fragments), subtype A no posterior comminution, subtype B posterior comminution. Type 3B and 1B are the most common fracture types. From Dubberley JH, Faber KJ, MacDermid JC, et al. Outcome after open reduction and internal fixation of capitellar and trochlear fractures. J Bone Joint Surg Am 2006; 88: 46–54. doi:10.2106/JBJS .D.02954. With permission.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8359569/v1/0ab468742c9a14a22fa0cdd7.jpeg"},{"id":99316891,"identity":"c41dcce3-307c-41ca-9c77-062f9c2bd5c0","added_by":"auto","created_at":"2025-12-31 16:29:23","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":294079,"visible":true,"origin":"","legend":"\u003cp\u003eTreatment algorithm for coronal shear fractures. ORIF should be considered in most patients. Primary arthroplasty can indeed be an option in elderly patients with poor chondral bone stock. This treatment algorithm was design by the authors. \u003csup\u003e1\u003c/sup\u003e: rheumatic arthritis, reduced life expectancy, malignoma\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8359569/v1/18a7242c9e27982bff0d9637.jpeg"},{"id":99317731,"identity":"a10f8556-2368-41e5-a609-fb86aa7dd25e","added_by":"auto","created_at":"2025-12-31 16:30:39","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":45780,"visible":true,"origin":"","legend":"\u003cp\u003eComplications and revision surgeries\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8359569/v1/ab94d1aaed9f4dcc6ced8076.png"},{"id":108437910,"identity":"76cc6366-df84-4c79-ad04-8979dc62eab6","added_by":"auto","created_at":"2026-05-04 16:04:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1244548,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8359569/v1/3eb48b19-9f8c-4b75-a8a4-5a851f886fd2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Surgical treatment of coronal shear fractures: short- to mid-term results and risk factor analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCoronal shear fractures are rare injuries and account for about 1% of all elbow fractures and up to 6% of all distal humerus fractures [62]. More than 80% of the fractures occur in elderly people, especially females, due to lower bone density, increased cubitus valgus or recurvatum [21,36,37,46,49]. In younger patients, high-energy trauma mechanisms are more common. The injury typically occurs after a low-energy fall onto an outstretched hand and hyperextended or semi flexed elbow. The axial force is transduced through the radial head and produces a coronal plane line fracture. Additionally, a posterolateral elbow dislocation or subluxation can also lead to a coronal shear fracture, when the radial head shears off the capitulum during reposition of the joint [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. These two mechanisms can also explain the high incidence of concomitant injuries. While half of the coronal shear fractures occur in isolation, up to 50% are associated with concomitant injuries such as radial head fractures, rupture of the lateral collateral ligament and coronoid fracture [1,12,26,44].\u003c/p\u003e \u003cp\u003eOpen reduction and internal fixation (ORIF) is the recommended treatment in the current management of coronal shear fractures to achieve stable anatomic reduction, restore articular congruity and initiate early motion [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, the fixation of these fractures is often very challenging, due to multiple, small fragments which do not allow stable fixation. Therefore, coronal shear fractures, especially higher degree, are often associated with poor functional outcome. Complications such as restriction of ROM, irritation of the ulnaris nerve, hardware complications, heterotopic ossifications or osteoarthritis can occur [1,12,26,44]. Therefore, there is an ongoing discussion in the literature whether an open fixation or a primary replacement should be performed, especially in elderly patients. However, the risks of a primary replacement such as loosening and life-long weight limitation also need to be considered. Due to its rare nature as well as a high individual heterogeneity in previous study groups, valid data on coronal shear fractures is rare. Even though there are a few short-term results, there are almost no mid-to long- term studies currently available. Therefore, the aim of this study was to evaluate the functional and clinical outcome after primary reconstruction of coronal shear fractures in a short- to mid-term follow-up and to identify potential risk factors for a poor outcome.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis was a retrospective case series performed at a single level I trauma center. The patients were identified by searching the clinic\u0026rsquo;s patient management system (Medico; Cerner Health\u003c/p\u003e \u003cp\u003eServices, Idstein, Germany) from 2012 to 2022 for all coronal shear fractures using ICD code S 42.49 (International classification of diseases, 10th edition) with a follow-up period of at least 2 years. In addition, patients were only eligible for inclusion if they were aged\u0026thinsp;\u0026gt;\u0026thinsp;18 years and had not undergone previous surgical procedures or sustained prior injuries to the affected elbow (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). All fractures were classified according to the Dubberley classification system using preoperative CT scans [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Mostly fractures were type 1B and 3B fractures followed by 1A fractures. For detailed classification see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurgical approach and treatment\u003c/h3\u003e\n\u003cp\u003eWe developed an algorithm that was used for treatment choice (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). When ORIF was performed, the lateral approach through the Kocher interval was primarily used. Proceeding through the subcutaneous tissues and dissection of the anterior capsule, the distal humerus was exposed. If the fracture extended to the medial side and in all Dubberley 3 fractures, an additional medial approach was used (n\u0026thinsp;=\u0026thinsp;18). Reduction was performed and the fragments were temporarily stabilized with K-wires. The main goal was to obtain anatomic reduction and to restore the congruity of the joint surface as well as to achieve a stable reconstruction. Definitive fixation was obtained through cannulated headless compression screws (Medartis, Basel, Switzerland). In fractures with posterior comminution, an additional precontoured locking plate from dorsolateral (VA-LCP distal humeral plate, DePuy Synthes, Zuchwil, Solothurn, Switzerland) was administered through the Kocher approach, working as a template for distal humerus inclination as well as to increase stability and to reduce forces on the single screws. The lateral collateral ligament, when injured, was reinserted to its humeral origin using transosseous sutures or screw anchors. Postoperatively, the elbow was splinted in a cast at 90\u0026deg; of flexion for one week, following an early active motion protocol using a dynamic splint for additional 5 weeks. All patients were instructed to perform range-of-motion (ROM) exercises without wearing the brace to minimize joint stiffness while maintaining stability. If the patients hat no contraindication, they received oral nonsteroidal anti-inflammatory medication for 2 weeks as ossification prophylaxis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eOutcome measures\u003c/h3\u003e\n\u003cp\u003eAfter a minimum follow-up period of 2 years, the patients were invited to undergo a clinical evaluation by an independent investigator. The range of motion (ROM) of both elbow joints was tested using a standard goniometer, and ligamentous stability was measured using valgus and varus stress tests. Elbow stiffness was rated according to the degree of the residual arc of motion. Functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), and the German version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. All available radiographs were evaluated by 2 independent investigators (A.K and L.C.). Radiographic signs of osteoarthritis (OA) were rated according to the Broberg-Morrey classification (mild, moderate and severe) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Heterotopic ossification (HO) was graded using the system of Hastings and Graham [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A Jamar dynamometer (Fabrication Enterprises, White Plains, NY, USA) was used to assess grip strength compared with the uninjured side, with the application of a correction factor of 1.07 for the dominant hand over the nondominant hand [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Complications were defined as adverse events directly related to the surgical treatment, including persistent elbow stiffness (defined as ROM\u0026thinsp;\u0026lt;\u0026thinsp;60\u0026deg; in extension-flexion at 6 months following initial procedure), ulnar nerve injury, hardware failure and non-union. Revision was defined as any subsequent surgical intervention related to the index procedure.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was conducted using IBM SPSS Statistics software (version 25; IBM Germany, Ehningen, Germany). The Chi\u003csup\u003e2\u003c/sup\u003e test was used to determine statistical differences in categorical data such as complication rate, reoperation rate, HO, and OA. Mean values were compared using the Mann-Whitney U test for nonparametric variables. In addition, bivariate regression analyses were performed to determine which demographic and clinical variables were independently predictive of a poor outcome (defined as MEPS\u0026thinsp;\u0026lt;\u0026thinsp;70 points). Predictors used in the bivariate model included those that were statistically significant on bivariate analysis and those generally accepted in the literature to be potential confounders. P values were reported. Correlations between these variables were analyzed using the F coefficient (Pearson correlation coefficient for binary variables) and its associated P value. P\u0026thinsp;\u0026lt;\u0026thinsp;.05 was considered significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eClinical and functional results\u003c/h2\u003e \u003cp\u003ePatient demographic characteristics are detailed in Table I. The average follow-up period was 49 months (range, 7-135 months). At final follow-up, the average range of motion was 136\u0026deg; (range, 100\u0026ndash;140) for flexion, 0\u0026deg; (range, -10-10) for extension, 87\u0026deg; (range, 60\u0026ndash;90\u0026deg;) for pronation, and 85\u0026deg; (range, 10\u0026ndash;90\u0026deg;) for supination, both of which differed significantly compared with the unaffected side (P\u0026thinsp;\u0026lt;\u0026thinsp;.001). There was no extension deficit on the injured site. At the final visit, the mean MEPS was 90,0 (range, 40\u0026ndash;100), the mean OES was 38,4 (range, 18\u0026ndash;48), and the mean DASH Score was 16,7 (range, 0\u0026ndash;69). Mean grip strength measured 92.9% (range, 53,4-144%) compared with the uninjured arm, with approximately one third of the patients regaining full grip strength compared to the uninjured side.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003edemographic results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003echaracteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003edata\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePopulation, n\u003c/p\u003e \u003cp\u003eFemale % (n)\u003c/p\u003e \u003cp\u003eMale % (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003cp\u003e58,8 (30)\u003c/p\u003e \u003cp\u003e41,2 (21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean follow up (range), months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (24\u0026ndash;135)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age at surgery (range), yr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52,2 (18\u0026ndash;78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epatients age\u0026thinsp;\u0026lt;\u0026thinsp;70 years, % (n)\u003c/p\u003e \u003cp\u003epatients age\u0026thinsp;\u0026gt;\u0026thinsp;70 years, % (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88,2 (45)\u003c/p\u003e \u003cp\u003e11,8 (6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edominant site injured % (n)\u003c/p\u003e \u003cp\u003enon dominant site injured %(n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39,2 (20)\u003c/p\u003e \u003cp\u003e60,8 (31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean BMI (range), kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eBMI\u0026thinsp;\u0026lt;\u0026thinsp;25, % (n)\u003c/p\u003e \u003cp\u003eBMI\u0026thinsp;\u0026gt;\u0026thinsp;25, % (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25,5 (17,0\u0026ndash;42,0)\u003c/p\u003e \u003cp\u003e62,7 (32)\u003c/p\u003e \u003cp\u003e37,3 (19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen fracture, % (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,9 (2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean time to surgery, days (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,8 (0\u0026ndash;20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean surgery time, min (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e125,2 (39\u0026ndash;313)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRadiographic outcome\u003c/h3\u003e\n\u003cp\u003eThere were no signs of hardware failure. All patients showed fracture union at follow up. Avascular necrosis occurred in 1 patient. This patient did not show any functional or clinical restrictions, no further intervention was needed. According to the Broberg and Morrey classification system, signs of osteoarthritis were observed in 23 of 51 patients (45,1%). Mild osteoarthritis occurred in 14 patients, moderate osteoarthritis in 7 patients and severe osteoarthritis in 2 patients (humeroulnar 65,2% (n\u0026thinsp;=\u0026thinsp;15), radiocapitellar 34,8% (n\u0026thinsp;=\u0026thinsp;8)).\u003c/p\u003e \u003cp\u003eCompared to the patients without osteoarthritis, the MEPS and DASH Score showed an inferior outcome in the osteoarthritis group although not statistically significant (p\u0026thinsp;=\u0026thinsp;0,211 und p\u0026thinsp;=\u0026thinsp;0,242). The extension and flexion were significantly worse in patients with signs of osteoarthritis (p\u0026thinsp;=\u0026thinsp;0,038), whereas the pro- and supination was not impaired (p\u0026thinsp;=\u0026thinsp;0,887). Osteoarthritis had the tendency to occur more often in Dubberley type B fractures without statistical significance (p\u0026thinsp;=\u0026thinsp;0,276).\u003c/p\u003e \u003cp\u003eHeterotopic ossifications occurred in 12 of 51 patients (23,5%), mainly stage 1 (9 patients), 2 stage 2A and 1 stage 3, but there was no inferior outcome in the patients showing signs of heterotopic ossifications.\u003c/p\u003e\n\u003ch3\u003eComplications\u003c/h3\u003e\n\u003cp\u003eAll complications and revisions are summarized in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. 35,3% of our patients (n\u0026thinsp;=\u0026thinsp;19) experienced complications during follow-up, and 14 patients (27,4%) required additional surgical treatment during follow-up.\u003c/p\u003e \u003cp\u003eMost of the complications were due to ongoing severe joint stiffness (n\u0026thinsp;=\u0026thinsp;11) and hardware irritation of a dorsal plate (n\u0026thinsp;=\u0026thinsp;5). In these cases, surgical arthrolysis and removal of the hardware was performed.\u003c/p\u003e \u003cp\u003eNo patient with reconstruction required the implantation of a secondary prosthesis. 86,6% of the complications occurred in Dubberley type B fractures (P\u0026thinsp;=\u0026thinsp;0,001), although, the functional results were still good (MEPS 89,0, DASH 19,1, OES 37,5).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eRisk factors for a poor outcome\u003c/h2\u003e \u003cp\u003eThe variables that were tested against a poor outcome (MEPS\u0026thinsp;\u0026lt;\u0026thinsp;70 points) after osteosynthesis are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, which have previously been described in the literature. Age was dichotomized (\u0026lt;\u0026thinsp;70 years vs. \u0026gt;70 years) for regression analysis. Univariate regression analysis was performed for increasing Dubberley classification, posterior comminution, and injury of the dominant site were significantly associated with a poor outcome. Surprisingly, age and BMI did not show any significant differences between these groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Intervariable correlations could be detected for increasing Dubberley classification and Dubberley type B fracture (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eresults of univariant regression analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% KI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u0026thinsp;\u0026gt;\u0026thinsp;70 y\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0,390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,78\u0026thinsp;\u0026minus;\u0026thinsp;0,97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemale sex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0,311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3,08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,32\u0026thinsp;\u0026minus;\u0026thinsp;29,71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDubberley type 2,3 or 4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0,003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,02\u0026thinsp;\u0026minus;\u0026thinsp;1,45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDubberley type B\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0,002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,50\u0026thinsp;\u0026minus;\u0026thinsp;1,92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDominant site\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0,003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,58\u0026thinsp;\u0026minus;\u0026thinsp;0,97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOsteoarthritis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0,481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,08\u0026thinsp;\u0026minus;\u0026thinsp;3,37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI\u0026thinsp;\u0026gt;\u0026thinsp;25\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0,894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,17\u0026thinsp;\u0026minus;\u0026thinsp;7,50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFracture of the radial head\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0,739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,01\u0026ndash;1,22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExtensor rupture\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0,561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,01\u0026ndash;1,22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMCL rupture\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0,768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,00\u0026ndash;1,18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLCL rupture\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0,754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,01\u0026ndash;1,23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccurance of complications/revisions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0,373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,45\u0026thinsp;\u0026minus;\u0026thinsp;0,98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eBMI\u0026thinsp;=\u0026thinsp;Body mass index; MCL: medial collateral ligament; LCL: lateral collateral ligament; \u003cb\u003ebold\u003c/b\u003e\u0026thinsp;=\u0026thinsp;statistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eresults of multivariate regression analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRegression coeffizient\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDubberley type 2,3,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0,004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,272\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDubberley type B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0,003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,341\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDominant site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0,149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0,186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003eRegression\u003c/p\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,521\u003c/p\u003e \u003cp\u003e0,271\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003ebold\u003c/b\u003e\u0026thinsp;=\u0026thinsp;statistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eCoronal shear fractures are rare injuries and account for about 6% of all elbow fractures. Due to their demographic correlations, they are usually associated with low bone density, and multifragmentary fractures. Initial treatments range from conservative to open reduction and internal refixation (ORIF) to total elbow arthroplasty (TEA), however there is no consensus about choosing the right treatment according to the fracture type and patient [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. ORIF is mostly recommended when stable fixation is possible allowing anatomic reconstruction and early motion. However, the presence of comminution and low bone density makes it a difficult procedure in the elderly patient. For this reason, elbow arthroplasty has been an alternative surgical option, especially in elderly patients [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Still, due to the plethora of complications associated with TEA, like loosening and weight restriction, there is an ongoing debate, which patients are best treated with osteosynthetic reconstruction. In this study, we present the short- to mid-term outcomes of the largest single-center cohort of patients with coronal shear fracture which were all treated with ORIF.\u003c/p\u003e \u003cp\u003eFor standardized treatment, widely used classification systems and treatment algorithms are required to ensure valid treatment. Watson et al. implemented the Modified Dubberley Classification System by adding a forth type (multiple fragment in multiple planes) to the already known Dubberley classification [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. For type A fractures they suggest screw fixation as well as an antiglide plate if needed. For type 1B and 2B fractures posterolateral plating as well as bone grafting can be used. In type 3B and 4B fractures they suggest using additional medial plating or arthroplasty. Using this system to classify the fractures preoperatively, Shergold et al. and Mukohara et al. showed good functional outcomes despite the fracture type [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The worse outcomes with increasing Dubberley classification confirm the Dubberley classification as a good prognosis prediction tool [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In our opinion, despite the fracture classification, patient factors are similarly relevant for treatment decision and should be also considered. We additionally present a treatment algorithm to simplify the decision which treatment should be used [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. As shown, we suggest, if stable fixation is achievable, despite a comminuted fracture pattern, to use ORIF as the surgical treatment. However, if certain risk factors are present and stable fixation is not possible, we recommend either hemi or total elbow arthroplasty. We want to point out that this treatment algorithm is intended as an orientation, and an individual decision is often necessary concerning the factors mentioned before.\u003c/p\u003e \u003cp\u003eIn the overall population the functional outcome in our cohort was good with MEPS, DASH and OES all showing good to excellent results. These results are comparable with the scores from a prior case series. Lopiz et al. reported an average MEPS of 92,2 at similar follow up after ORIF, Mukohara et al. reported 96,3 at only 15 months of follow up [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Hulet et al. reported still excellent results with an average MEPS score of 94,9 at the longest follow up found in the literature with 76 months [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Therefore, our study adds to the good functional outcomes after ORIF reported in other studies which underlines the necessity of a successful osteosynthesis (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, we reported high rates of complications (35,3%) and reoperations (27,4%), which could be related to our definition of a complication, as we also included elbow stiffness, which is a common finding after a complex elbow fracture [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Likewise, it remains unclear, how other authors define \u0026ldquo;complication\u0026rdquo;, with some of them including radiographic findings, while others only consider clinical complications or reoperations [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. If ulnar nerve parasthesia, nonunion or loss of reduction, and restriction of ROM are considered reoperation rates are reported to be as high as 50% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The high complication rate observed in our study could also be attributed to significant portion of complex injuries (type B 70,6%). However, it is also important to mention that despite the occurrence of a follow-up complication, patients still achieved good overall functional results. Nevertheless, patients must be informed preoperatively about high complication rates and the different treatment types.\u003c/p\u003e \u003cp\u003eDespite treating a high number of complex cases (Dubberly 3/B, n\u0026thinsp;=\u0026thinsp;18) nonunion did not occur. We explain that by good anatomic reduction and reconstruction of the lateral and medial columns which contributes to enhance the blood supply and therefore fracture healing [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDegenerative changes were seen in 45,1%, however these were mainly mild. These findings are similar to the current literature, with osteoarthritic signs being reported in up to 40% of the cases [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Osteoarthritis in elbow fractures is complex and multifactorial. However, occult cartilage damage caused by the initial trauma and persistent instability seem to be important factors [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Therefore, it is rather obvious that osteoarthritis is more frequently seen in type B fractures. However, the presence of osteoarthritis changes did not impact the functional outcome despite lower ROM, the patients\u0026acute; daily activities were not impaired in our study. Consequently, no secondary procedures were required. Lopiz et al. reported mild osteoarthritis in 15%, however they found significantly lower functional scores compared to patients with no osteoarthritic signs (MEPS 70/96, p\u0026thinsp;=\u0026thinsp;0,05) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Nevertheless, this complication requires longer term evaluation since osteoarthritic changes can worsen and further treatment might be necessary leading to further treatment or surgery.\u003c/p\u003e \u003cp\u003eHeterotopic ossifications were seen in 23,5%, mostly in type B fractures. As reported in the literature, heterotopic ossifications occur in 0\u0026ndash;47% of all cases but are mostly low grade and asymptomatic. They are associated with increasing Dubberley classification and therefore posterior comminution, extended approaches can lead to heterotopic ossifications [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Nevertheless, heterotopic ossifications were mainly asymptomatic and did not require further surgery in our study.\u003c/p\u003e \u003cp\u003eThe most important factor for a poor postoperative outcome in our study was the degree of comminution. These findings are consistent with the findings in other studies, where average arc reduction of 25\u0026deg; was reported when comparing type 3 to type 1 fractures [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Ruchelsman et al. as well as McKee et al. both reported decreased arc of motion and lower MEPS when comparing type 3 or 4 with type 1 fractures [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Increasing Dubberley classification often accompanies increased severity of the articular injury, the presence of concomitant injuries such as radial head fractures, and the extended surgical dissection that is needed to facilitate exposure and visibility of the anterior articular fragments [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] Despite the need for counseling patients about the possibility of developing flexion contractures and lower range of motion compared to the healthy site, a functional range of motion is still achievable as our results and aforementioned studies suggest [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In addition to the factors mentioned before, posterior comminution was also associated with a poor functional outcome in our study. These findings are consistent to the studies by Ashwood et al and Durakbasa et al. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. If posterior comminution is present, further plating is often required to restore the humeral offset and adequate joint congruity [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In addition, persistent instability that comes with posterior comminution can also lead to flexion-extension contractures and lower functional outcome and patients\u0026acute; satisfaction. An additional plate and further fixation are required to buttress the humeral comminution, to restore humeral offset and to gain adequate purchase and stability [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This may allow stable fixation and early range of motion [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Despite optimal surgical treatment, patients with comminuted fractures are still at high risk to have lower functional results and range of motion [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our cohort no conversion into a secondary elbow arthroplasty was performed. Durakbasa et al., Shergold et al. and Mukohara et al. all recommend using ORIF in (mainly young) patients to restore articular congruity. In elderly people, total elbow arthroplasty could be an option if stable fixation is not possible. Shergold et al. reported more severe complications in ORIF than in TEA, Mukohara et al. reported a lower MEPS in multifragmentary fractures when severe fractures were treated with ORIF compared to TEA [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. However, Tomori et al. recently reported good functional results and little complications with ORIF in noncomminuted fractures in a small study including only elderly patients (n\u0026thinsp;=\u0026thinsp;8; average age 76,3 years) [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Based on our algorithm, a reconstruction is performed as long as a stable fixation can be achieved, independently of age. If stable fixation is not possible, individual patient factors such as age, comorbidities as well as patient\u0026acute;s demand should be considered [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In this context, Dirckx et al. compared hemiarthroplasty to ORIF at 34 months of follow up in multi fragmentary intraarticular distal humeral fractures. They showed comparable complication rates in hemiarthroplasty and ORIF, when an adequate fixation technique was used, concluding that ORIF might also be the preferrable option for selected elderly patients [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eElbow arthroplasty can be an option in elderly patients with poor subchondral bone stock or in complex comminuted fractures when stable anatomic fixation cannot be achieved. However, primary arthroplasty as fracture treatment should be chosen wisely concerning severe complications such as loosening, revision arthroplasty and infection.\u003c/p\u003e \u003cp\u003eThis study has some limitations. First, this was a retrospective, single-center study, which is inherently prone to bias (e.g., performance differences between the attending surgeons) and loss to follow-up. Second, the size of the total cohort and the number of patients in certain subgroups were rather small, limiting the ability to draw conclusions or to yield a more precise prediction model. However, this is the largest case series describing the functional outcomes of treatment of coronal shear fractures in the current literature. The short- to mid-term follow-up can lead to falsely low rates of long-term complications such as post-traumatic arthritis. However, a review of the literature indicates that a follow-up period of 3 years is considered sufficient for the assessment of stability, function, and most surgical complications in treatment studies [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFunctional results and overall complication rate after surgical treatment of coronal shear fractures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFU\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFunction\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFlex-ext\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePro-Sup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRO\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHulet et al. 2023 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76,6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDASH 6,8 (0\u0026ndash;25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e137\u0026deg; (130\u0026ndash;145\u0026deg;)\u003c/p\u003e \u003cp\u003e4\u0026deg; (0\u0026ndash;30\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e164\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38,9% (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShergold et al. 2022 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en. s.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e130\u0026deg; (110\u0026ndash;140\u0026deg;)\u003c/p\u003e \u003cp\u003e10\u0026deg; (0\u0026ndash;50\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e170 (140\u0026ndash;180)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26,7% (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e33,3% (15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTomori et al. 2022 [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23,6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEPI 78,8 (70\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100% (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYoshida et al. 2021 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEPI 83,8 (60\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6,25% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMukohara et al. 2021 [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEPI 96,3 (70\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e130\u0026deg; (100\u0026ndash;145\u0026deg;)\u003c/p\u003e \u003cp\u003e10\u0026deg; (-5-30\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e56,0% (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTarallo et al. 2021 [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEPI 92,1 (72,5-100)\u003c/p\u003e \u003cp\u003eBroberg 90,7 (72\u0026ndash;99,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ecomplete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16,7% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12,5% (3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeng und Zhong 2020 [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEPI 85,8 (70\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e167,4\u0026deg; (155\u0026ndash;175\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21,0% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSong et al. 2020 [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17,6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEPI 90,6 (60\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e136\u0026deg; (90\u0026ndash;150\u0026deg;)\u003c/p\u003e \u003cp\u003e3\u0026deg; (0\u0026ndash;15\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e180\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15,4% (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWang et al. 2019 [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEPI 89 (70\u0026ndash;95)\u003c/p\u003e \u003cp\u003eDASH 11,2 (4,2\u0026ndash;20,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e123,7\u0026deg; (110\u0026ndash;135\u0026deg;)\u003c/p\u003e \u003cp\u003e11\u0026deg; (5\u0026ndash;30\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e160,5\u0026deg; (140\u0026ndash;180\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26,7% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTanwar et al. 2018 [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDASH 24 (14,2\u0026ndash;35,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20,0% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarinelli et al. 2018 [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEPI 78 (60\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e51,1% (23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLopiz et al. 2016 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEPI 92,7 (60\u0026ndash;100)\u003c/p\u003e \u003cp\u003eDASH 9,8 (0\u0026ndash;75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e122\u0026deg; (100\u0026ndash;135\u0026deg;)\u003c/p\u003e \u003cp\u003e8\u0026deg; (0\u0026ndash;30\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e167\u0026deg; (90\u0026ndash;180\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e55,0% (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRavishankar et al. 2016 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24,6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEPI 80,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e151\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27,3% (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTarallo et al. 2015 [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEPI 92 (78\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e125\u0026deg; (100\u0026ndash;140\u0026deg;)\u003c/p\u003e \u003cp\u003e20\u0026deg; (10\u0026ndash;40\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e141,5\u0026deg; (130\u0026ndash;150\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37,5% (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDurakbasa et al. 2013 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEPI 83,3 (60\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e53,3% (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAshwood et al. 2010 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEPI 81,3 (65\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e128,8\u0026deg; (119,5-134\u0026deg;)\u003c/p\u003e \u003cp\u003e14,1\u0026deg; (7,5\u0026ndash;20,5\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e108,9\u0026deg; (83\u0026ndash;132\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30,8% (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23,1% (6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMighell et al. 2010 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eASES 83,1 (21,3-100)\u003c/p\u003e \u003cp\u003eBroberg 93,3 (57\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en.s.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e176\u0026deg; (120\u0026ndash;180\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e50,0% (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRuchelsmann et al. 2008 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEPI 91,6 (65\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e133\u0026deg; (100\u0026deg;\u0026ndash;150\u0026deg;)\u003c/p\u003e \u003cp\u003e10\u0026deg; (0\u0026deg;\u0026ndash;45\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e180\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e75,0% (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6,2% (1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDubberley et al. 2006 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMEPI 91 (65\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e138\u0026deg; (129,3-144,8\u0026deg;)\u003c/p\u003e \u003cp\u003e19 (1\u0026ndash;35\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e156\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60,7% (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42,8% (12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eFU\u0026thinsp;=\u0026thinsp;Follow-Up; OC\u0026thinsp;=\u0026thinsp;overall complications; RO\u0026thinsp;=\u0026thinsp;reoperations; n.s.= not specified\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSatisfactory short- to mid-term functional outcomes can be achieved using osteosynthetic reconstruction in patients with acute coronal shear fractures. However, complication and revision rates are substantial, frequently leading to inferior outcome scores. Additionally, a higher grade of Dubberley classification, as well as the presence of posterior comminution were associated with a poor outcome; in contrast, a higher age and BMI did not show any differences in outcome. These factors should raise awareness by the trauma surgeon choosing the surgical treatment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eThe authors did not receive support from any organization for the submitted work.\u003c/li\u003e\n \u003cli\u003eNo funding was received for conducting this study.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eCompeting interest\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eAll authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eEthics Approval\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eAll procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee of\u0026nbsp;Landesärztekammer Hessen (2020-2100-evBO).\u0026nbsp;There are no ethical or legal concerns regarding this study.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eInformed consent\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eWritten informed consent was obtained from all subjects before the study.\u0026nbsp;Patients signed informed consent regarding publishing their data and photographs.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eData\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eResearch data was generated in this study. All data supporting the findings of this study are available within the paper.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAuthors contribution\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eA.B. wrote the main manuscript text including figures and table.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eL.C. collected data and reviewed the manuscript.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eM.S. reviewed the manuscript and contributed to the treatment algorithm.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eT.J. reviewed the manuscript and reviewed the data.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eM.M. reviewed the manuscript.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eA.K. reviewed the manuscript, analyzed the data and contributed mainly to the treatment algorithm.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAshwood N, Verma M, Hamlet M, Garlapati A, Fogg Q. Transarticular shear fractures of the distal humerus. 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Coronal shear fractures of the distal humerus: Current concepts and surgical techniques. Shoulder Elb. 2020;12(2):124\u0026ndash;35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1758573219826529\u003c/span\u003e\u003cspan address=\"10.1177/1758573219826529\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoshida S, Sakai K, Nakama K, Matsuura M, Okazaki S, Jimbo K, et al. Treatment of Capitellum and Trochlea Fractures Using Headless Compression Screws and a Combination of Dorsolateral Locking Plates. Cureus. 2021;13(3):e13740. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.13740\u003c/span\u003e\u003cspan address=\"10.7759/cureus.13740\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-trauma-and-emergency-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejot","sideBox":"Learn more about [European Journal of Trauma and Emergency Surgery](http://link.springer.com/journal/68)","snPcode":"68","submissionUrl":"https://submission.nature.com/new-submission/68/3","title":"European Journal of Trauma and Emergency Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Coronal shear fractures, functional results, short- to mid-term follow up, osteosynthetic reconstruction","lastPublishedDoi":"10.21203/rs.3.rs-8359569/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8359569/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCoronal shear fractures of the distal humerus are rare but severe injuries. Reconstruction is often challenging, especially in comminuted and multifragmentary cases, which is why many surgeons opt for an elbow replacement in those cases. However, total elbow arthroplasty is associated with a variety of potential problems itself. Therefore, the aim of this study was to present the functional and clinical outcome of coronal shear fractures treated by osteosynthetic reconstruction in a short- to mid-term follow up, and to identify possible risk factors for an inferior outcome.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe performed a retrospective follow-up assessment of 51 consecutive patients (30 women and 21 men; mean age, 52,2 years (range 18\u0026ndash;78)) who underwent osteosynthetic reconstruction for coronal shear fractures between 2012 und 2022 after a minimum follow-up period of 2 years. The Mayo Elbow Performance Score, Oxford Elbow Score, and Disabilities of the Arm, Shoulder and Hand Score, were evaluated, and all available radiographs were analyzed. All complications and revision procedures were assessed. Bivariate and multivariate regression analyses were performed to identify potential risk factors for a poor outcome following osteosynthetic reconstruction.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAfter an average follow-up period of 49 months (range, 24\u0026ndash;134 months), the mean Mayo Elbow Performance Score was 90,0 (range, 40\u0026ndash;100), the mean Oxford Elbow Score 38,4 (range, 18\u0026ndash;48), and mean Disabilities of the Arm, Shoulder and Hand Score 16,7 (range, 0\u0026ndash;69). The average range of motion was 136\u0026deg; (range, 100\u0026ndash;140\u0026deg;) for flexion, 0\u0026deg; (range, -10-10) for extension, 87\u0026deg; (range, 60\u0026ndash;90\u0026deg;) for pronation, and 85\u0026deg; (range, 10\u0026ndash;90\u0026deg;) for supination. There was no extension deficit on the injured site. The overall complication and reoperation rates were 35.3% and 27.4%, respectively, with severe elbow stiffness being the most common reason for revision. Increasing Dubberley classification and posterior comminution were significantly associated with a poor outcome and higher rates of complications and revision.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis short- to mid-term follow up shows good functional results after osteosynthetic reconstruction in coronal shear fractures despite high complication and revision rates. However, increasing Dubberley classification, posterior comminution and the presence of complications show inferior outcome scores. This study shows that osteosynthetic reconstruction can be an option even in comminuted coronal shear fractures. Nevertheless, patient factors need to be considered and an individual decision concerning the surgical treatment is necessary. Patients should be counseled about the high complication rates and inferior outcome with increasing Dubberley classification.\u003c/p\u003e\u003ch2\u003eLevel of Evidence\u003c/h2\u003e \u003cp\u003eLevel III\u003c/p\u003e","manuscriptTitle":"Surgical treatment of coronal shear fractures: short- to mid-term results and risk factor analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 08:49:16","doi":"10.21203/rs.3.rs-8359569/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-13T08:07:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-12T19:42:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"154107261540692175305076246342883682034","date":"2026-02-12T11:41:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-23T09:42:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336311060632314448111186732632203618439","date":"2025-12-23T06:26:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-23T06:23:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-22T21:07:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-20T11:40:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Trauma and Emergency Surgery","date":"2025-12-14T17:10:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-trauma-and-emergency-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejot","sideBox":"Learn more about [European Journal of Trauma and Emergency Surgery](http://link.springer.com/journal/68)","snPcode":"68","submissionUrl":"https://submission.nature.com/new-submission/68/3","title":"European Journal of Trauma and Emergency Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"5695ffde-0f29-4ae3-9732-c45eced68ed6","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T16:03:39+00:00","versionOfRecord":{"articleIdentity":"rs-8359569","link":"https://doi.org/10.1007/s00068-026-03192-7","journal":{"identity":"european-journal-of-trauma-and-emergency-surgery","isVorOnly":false,"title":"European Journal of Trauma and Emergency Surgery"},"publishedOn":"2026-04-30 15:58:24","publishedOnDateReadable":"April 30th, 2026"},"versionCreatedAt":"2025-12-30 08:49:16","video":"","vorDoi":"10.1007/s00068-026-03192-7","vorDoiUrl":"https://doi.org/10.1007/s00068-026-03192-7","workflowStages":[]},"version":"v1","identity":"rs-8359569","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8359569","identity":"rs-8359569","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}