Fractures of the proximal ulna: current concepts in surgical management

[摘要] Fractures of the proximal ulna range in severity 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).1,2 While these fractures are common injuries in the upper extremity at any age, in adults they peak during the seventh decade of life.3 The anatomical restoration of ulnar alignment (in length, rotation and axis) has to be the primary goal of surgical treatment to regain an unrestricted elbow function. Thus, the surgeon carefully needs to address all aspects of the injury to allow early (active) rehabilitation and thereby prevent elbow stiffness.4 An improper osseous reconstruction of the ulna as well as a failed/missed reattachment of elbow stabilizing structures will otherwise result in persistent pain, poor function and progressive joint degeneration due to chronic elbow instability.5 Consequently, the appropriate treatment of proximal ulna fractures still remains a challenge for the orthopaedic surgeon. The aim of this review article is to illustrate the proper surgical management of these complex injuries using modern osteosynthetic implants and novel techniques while taking the complex biomechanics of the elbow joint into account.

[学科分类] 神经科学

[关键词] coronoid process;elbow stability;Monteggia fracture;Monteggia-like lesion;olecranon;proximal ulna fracture;radial head