Fractures of the proximal ulna: current concepts in surgical management

Abstract

Fractures of the proximal ulna range from simple olecranon fractures to complex Monteggia fractures or Monteggia-like lesions involving damage to stabilizing key structures of the elbow (i.e. coronoid process, radial head, collateral ligament complex).In complex fracture patterns a computerized tomography scan is essential to properly assess the injury severity.Exact preoperative planning for the surgical approach is vital to adequately address all fracture parts (base coronoid fragments first).The management of olecranon fractures primarily comprises tension-band wiring in simple fractures as a valid treatment option, but modern plate techniques, especially in comminuted or osteoporotic fracture types, can reduce implant failure and potential implant-related soft tissue irritation.For Monteggia injuries, the accurate anatomical restoration of ulnar alignment and dimensions is crucial to adjust the radiocapitellar joint.Caution is advised if the anteromedial facet (anatomical insertion of the medial collateral ligament) of the coronoid process is affected, to avoid posteromedial instability.Radial head reconstruction or replacement is essential in Monteggia-like lesions to restore normal elbow function.The postoperative rehabilitation programme should involve active elbow motion exercises without limitations as early as possible following surgery to avoid joint stiffness.Cite this article: EFORT Open Rev 2019;4:1-9. DOI: 10.1302/2058-5241.4.180022.

Surgical Importance of Radiographically Aided Morphometry of the Proximal Ulna

“…In addition, the discrepancy of values in the literature may vary by the different definition of the landmarks (Windisch et al, 2007b;Puchwein et al;Totlis et al;Beser et al;Adikrishna et al). For example; proximal ulna shows a gradual anterior deviation, starting from the middle and proximal one-third of the ulna and becomes more prominent proximally at the metaphysis (Siebenlist et al, 2019). The fact that a single landmark for MAA can not be choosen by all researchers globally and this can lead to differences which can be reasonably observed.…”

Nailing vs. plating in comminuted proximal ulna fractures – a biomechanical analysis

“…The standard treatment option for a comminuted proximal ulna fracture is locked plating [ 18 ]. Restoration of the complex anatomy of the proximal ulna is the key factor for a good functional outcome according to many authors [ 18 – 20 ]. The quality of reduction of proximal ulna fractures also depends on the implant used for fixation.…”

Comparison of Bending Strength among Plate, Steinmann Pin, and Headless Compression Screw Fixations for Proximal Ulnar Shaft Fracture in Sawbones

“…Of course, there are anatomical plates manufactured considering such an anatomical structure, pyromellitic dianhydride and oxydianiline required for plating. However, it is not technically easy because it does not take into account the individual patient's anatomical variance, and can lead to malunion or Monteggia fracture dislocation if it goes wrong [15]. The last drawback is that the bone itself is weak due to the bone hole that is drilled during plating, and there is a high possibility of refracture when removing the internal fixation device [1,10].…”