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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

The Role of the Critical Coronoid Angle in Simple Elbow Dislocation: A Computed Tomography-Based Index to Stratify Elbow Dislocation Risk

by
Paolo Arrigoni
1,*,†,
Francesco Luceri
1,†,
Enrico Rosagrata
2,
Salvatore Sorrentino
3,
Dario Polli
3,4,
Andrea Zagarella
5,
Simone Cassin
2,
Valeria Vismara
2,
Alessandra Colozza
6,
Carlo Zaolino
1 and
Pietro Simone Randelli
7,8,9
1
Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
2
Scuola di Specializzazione in Ortopedia e Traumatologia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
3
Department of Physics, Politecnico di Milano, Piazza L. da Vinci 32, 20133 Milan, Italy
4
Consiglio Nazionale delle Ricerche—Institute for Photonics and Nanotechnologies (CNR-IFN), Piazza L. da Vinci 32, 20133 Milan, Italy
5
U.O.C. Radiodiagnostica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
6
Unità Operativa Ortopedia e Traumatologia, Ospedale Civile di Faenza, Viale Stradone, 9, 48018 Faenza, Italy
7
Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
8
Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
9
U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to the work.
J. Clin. Med. 2025, 14(10), 3323; https://doi.org/10.3390/jcm14103323
Submission received: 10 April 2025 / Revised: 25 April 2025 / Accepted: 3 May 2025 / Published: 9 May 2025
(This article belongs to the Section Nuclear Medicine & Radiology)
Versions Notes

Abstract

Introduction: Elbow primary stability is guaranteed by the anatomical congruency between the humeral trochlea and the greater sigmoid notch (GSN). Elbow dislocation typically occurs in a semi-extended position, but computed tomography (CT) scans are typically acquired at 90° of elbow flexion, which may misleadingly suggest that the apex of the coronoid aligns with the trochlear center of rotation. This study aims to evaluate the anatomical features of the coronoid and GSN in a dislocated versus non-dislocated group, demonstrating that a more prominent coronoid process is more commonly observed in elbows without dislocation compared to those with dislocation. Materials and Methods: A total of 50 CT scans, equally divided between dislocated elbows and non-dislocated elbows, were analyzed, and the critical coronoid angle (CCA) was measured on a specific slice of the CT scan (level of evidence III). The CCA was calculated from two lines that arise in the center of the GSN, with the first one crossing the coronoid tip and the second parallel to the posterior olecranon cortex. Results: A significant difference in the CCA (p < 0.001) between the two groups was highlighted. In particular, it was found that 14/25 patients from the dislocated elbow group had a CCA below or equal to 27°, and all the non-dislocated subjects had a CCA ≥ 27°. These preliminary results suggest that a CCA ≤ 27° could be a threshold for requiring further imaging of soft tissues or closer follow-up. This may result from either a hypoplastic coronoid process or a decreased concavity of the GSN. Based on the CCA values, a logistic regression model (DAM model) was proposed to associate a coefficient of protection to the CCA, the angle of flexion during dislocation (FdD), and a parameter X, which is a factor that encompasses the contribution of soft tissues. Conclusion: A low CCA is statistically more frequent in dislocated elbows versus non-dislocated ones, creating a specific anatomical condition. The CCA should be carefully evaluated by elbow surgeons to guide patient-specific treatment. The DAM model can permit the stratification of patients eligible for further diagnostic analysis.
Keywords: elbow dislocations; CT scans; coronoid angle; instability; indexes elbow dislocations; CT scans; coronoid angle; instability; indexes

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MDPI and ACS Style

Arrigoni, P.; Luceri, F.; Rosagrata, E.; Sorrentino, S.; Polli, D.; Zagarella, A.; Cassin, S.; Vismara, V.; Colozza, A.; Zaolino, C.; et al. The Role of the Critical Coronoid Angle in Simple Elbow Dislocation: A Computed Tomography-Based Index to Stratify Elbow Dislocation Risk. J. Clin. Med. 2025, 14, 3323. https://doi.org/10.3390/jcm14103323

AMA Style

Arrigoni P, Luceri F, Rosagrata E, Sorrentino S, Polli D, Zagarella A, Cassin S, Vismara V, Colozza A, Zaolino C, et al. The Role of the Critical Coronoid Angle in Simple Elbow Dislocation: A Computed Tomography-Based Index to Stratify Elbow Dislocation Risk. Journal of Clinical Medicine. 2025; 14(10):3323. https://doi.org/10.3390/jcm14103323

Chicago/Turabian Style

Arrigoni, Paolo, Francesco Luceri, Enrico Rosagrata, Salvatore Sorrentino, Dario Polli, Andrea Zagarella, Simone Cassin, Valeria Vismara, Alessandra Colozza, Carlo Zaolino, and et al. 2025. "The Role of the Critical Coronoid Angle in Simple Elbow Dislocation: A Computed Tomography-Based Index to Stratify Elbow Dislocation Risk" Journal of Clinical Medicine 14, no. 10: 3323. https://doi.org/10.3390/jcm14103323

APA Style

Arrigoni, P., Luceri, F., Rosagrata, E., Sorrentino, S., Polli, D., Zagarella, A., Cassin, S., Vismara, V., Colozza, A., Zaolino, C., & Randelli, P. S. (2025). The Role of the Critical Coronoid Angle in Simple Elbow Dislocation: A Computed Tomography-Based Index to Stratify Elbow Dislocation Risk. Journal of Clinical Medicine, 14(10), 3323. https://doi.org/10.3390/jcm14103323

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