Aims This study aimed to gather insights from elbow experts using the Delphi method to evaluate the influence of patient characteristics and fracture morphology on the choice between operative and nonoperative treatment for coronoid fractures. Methods A three-round electronic (e-)modified Delphi survey study was performed between March and December 2023. A total of 55 elbow surgeons from Asia, Australia, Europe, and North America participated, with 48 completing all questionnaires (87%). The panellists evaluated the factors identified as important in literature for treatment decision-making, using a Likert scale ranging from "strongly influences me to recommend nonoperative treatment" (1) to "strongly influences me to recommend operative treatment" (5). Factors achieving Likert scores ≤ 2.0 or ≥ 4.0 were deemed influential for treatment recommendation. Stable consensus is defined as an agreement of ≥ 80% in the second and third rounds. Results Of 68 factors considered important in the literature for treatment choice for coronoid fractures, 18 achieved a stable consensus to be influential. Influential factors with stable consensus that advocate for operative treatment were being a professional athlete, playing overhead sports, a history of subjective dislocation or subluxation during trauma, open fracture, crepitation with range of movement, > 2 mm opening during varus stress on radiological imaging, and having an anteromedial facet or basal coronoid fracture (O'Driscoll type 2 or 3). An anterolateral coronoid tip fracture ≤ 2 mm was the only influential factor with a stable consensus that advocates for nonoperative treatment. Most disagreement existed regarding the treatment for the terrible triad injury with an anterolateral coronoid tip fracture fragment ≤ 2 mm (O'Driscoll type 1 subtype 1). Conclusion This study gives insights into areas of consensus among surveyed elbow surgeons in choosing between operative and nonoperative management of coronoid fractures. These findings should be used in conjunction with previous patient cohort studies when discussing treatment options with patients.

中文翻译：

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与冠状动脉骨折治疗选择相关的因素。


目的 本研究旨在使用 Delphi 方法收集肘部专家的见解，以评估患者特征和骨折形态对冠状静脉骨折手术和非手术治疗选择的影响。方法 在 2023 年 3 月至 12 月期间进行了一项三轮电子 （e-） 改良 Delphi 调查研究。共有来自亚洲、澳大利亚、欧洲和北美的 55 名肘部外科医生参与，其中 48 名 （87%） 完成了所有问卷。小组成员使用李克特量表评估了文献中确定为治疗决策重要因素，范围从“强烈影响我推荐非手术治疗”（1） 到“强烈影响我推荐手术治疗”（5）。达到 Likert 评分≤ 2.0 或 ≥ 4.0 的因素被认为对治疗推荐有影响。稳定共识定义为在第二轮和第三轮中≥ 80% 的协议。结果 在文献中认为冠状结肠骨折治疗选择重要的 68 个因素中，18 个达成了有影响力的稳定共识。倡导手术治疗的具有稳定共识的影响因素是职业运动员、参加过顶运动、外伤期间主观脱位或半脱位病史、开放性骨折、活动范围捻发音、放射影像学上内翻应力期间 > 2 mm 张开，以及前内侧小关节或基底冠状突骨折（O'Driscoll 2 型或 3 型）。≤ 2 mm 的前外侧冠状突尖端骨折是唯一具有稳定共识的倡导非手术治疗的影响因素。 关于前外侧冠状突尖端骨折碎片 ≤ 2 mm 的可怕三联征损伤的治疗存在大多数分歧 （O'Driscoll 1 型亚型 1）。结论 本研究深入了解了受访肘部外科医生在冠状结肠骨折手术和非手术治疗之间进行选择的共识领域。在与患者讨论治疗方案时，这些发现应与以前的患者队列研究结合使用。