Proximal Ulna Fractures

Talk from Elbow Approaches and Trauma Masterclass in Cambridge 2015.

1. Proximal Ulna Fractures
Adam C Watts
Consultant Elbow and Upper Limb Surgeon, Wrightington
Hospital
Visiting Professor, Manchester University
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Overview
Olecranon fractures
Monteggia fracture dislocations

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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

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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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37. Isolated Olecranon Fracture
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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)

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Transolecranon
Monteggia Fracture Dislocations
Proximal ulna fracture with dislocation of radial head from
radiocapitellar joint and proximal radioulnar joint

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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

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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.

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Summary
Tension band wiring > 50% re-operation
Newer techniques reduce secondary surgery
Ulna alignment and coronoid key to success in
Monteggia fractures

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92 F Active
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