Proximal Ulna Fractures

Proximal Ulna Fractures

Adam C Watts Consultant Elbow and Upper Limb Surgeon, Wrightington

Hospital

Visiting Professor, Manchester University

1

www.wrightington.com 2

www.wrightington.com6

Overview

Olecranon fractures

Monteggia fracture dislocations


Undisplaced

Comminuted

Simple

Displaced Unstable

Mayo Classification

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Minimising complication / re-operation

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Anatomical reduction

Bicortical penetration

Subchondral placement

Patient selection

Fracture personality

Bone quality


Alternatives

Dorsal plating (30% re-operation v 50% with TBW)

Parallel plating

Intramedullary device

Suture repair

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Indications

Simple transverse or stable oblique fractures

Osteotomy

Very proximal fractures

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Isolated Olecranon Fracture


Super elderly / Low demand? Dementia? Unfit?

Non-operative

Is ulnohumeral joint stable?

Simple transverse/ stable oblique

Suture repair

Comminuted

YES NO

Plate Fixation(+/- suture repair)


Transolecranon Monteggia Fracture Dislocations

Proximal ulna fracture with dislocation of radial head from radiocapitellar joint and proximal radioulnar joint


Bado Classification

Anterior

Posterior

Lateral

Radial diaphyseal fracture

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Jupiter Classification of Type II Fractures

IIa Coronoid level

IIb Metaphyseal/Diaphyseal junction

IIc Distal to coronoid

IId Fracture extending to distal 1/2 ulna

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Ring Classification

Type I Apex anterior diaphyseal ulna fracture with anterolateral dislocation of radiocapitellar and PRUJ

Type II Metaphyseal buckle fractures with anterolateral radiocapitellar dislocation (paediatric only)

Type III Apex posterior ulna fractures with posterior dislocation radiocapitellar joint

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Aims of treatment

Restoration of normal ulna alignment

Restoration of elbow stability

coronoid buttress radial head lateral ligament complex

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Bado I, Ring I

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Jupiter IIb, Ring III

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Jupiter IIa, Ring III


Complication

Fixation failure - osteoporosis common

Ulna non-union

Ulno-humeral instability

Radio-ulna synostosis

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Outcome Monteggia Fractures

Anterior (Bado I, Ring I) good outcomes less likely to involve radial head or coronoid

Posterior (Bado II, Ring III) poor worse if unstable coronoid fracture present (Jupiter IIa)

coronoid / radial head fractures and re-operation associated with poorer outcome.


Summary

Tension band wiring > 50% re-operation

Newer techniques reduce secondary surgery

Ulna alignment and coronoid key to success in Monteggia fractures

Proximal Ulna Fractures

Health & Medicine

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