[Treatment of proximal ulnar comminuted fractures--a challenge]

Comminuted fractures of the proximal ulna are severe injuries often complicated by involvement of the elbow joint and damaged soft tissues. The treatment of these fractures is very demanding and the results often mediocre due to of ancillary injuries (Dislocation in the humero-ulnar joint and associated radial head fractures). We analyzed the results of the treatment of these fractures and investigated whether other factors than the severity of fracture type influenced the final outcome.

Retrospective analysis of 18 patients with comminuted proximal ulna fractures. These comminuted ulna fractures included not only C-fractures according the the AO classification but also A1, A3, B1 and B3 fractures. Postoperative clinical and radiological examinations were routinely performed at 1/2-1 year intervals following treatment according to bone healing and work begin. This was done up to 48 months following treatment. Elbow function was recorded one year after the accident using the Morrey score.

According the the AO classification, of the total of 18 patients, four suffered from an A-fracture, four from a B-fracture and 10 from a C-fracture. Eight of the 18 patients had an open fracture. 10/18 of the patients also had a fractured radial head and 9/18 of the cases had a dislocation of the humero-ulnar joint. The average range of motion based on a postoperative examination after one year was extension/flexion 0 degree/20 degrees/120 degrees and pronation/supination 70 degrees/0 degree/70 degrees. The assessment based on the Morrey-score indicated excellent to good results for 10 patients, average results for four patients and poor results for four patients.

Despite correct diagnosis of the severity of injury and adequate treatment the results are only mediocre due to associated injuries (dislocation, radial head fractures). The goal is a stable anatomic reconstruction to allow early functional treatment.