Resection of comminuted ulna head fragments with soft tissue reconstruction when associated with distal radius...

Acute management of fractures involving the head and neck of the distal ulna associated with comminuted unstable fractures of the distal radius remains difficult and controversial. Fifteen consecutive such cases treated with combined external and internal fixation together with primary resection of comminuted distal ulna fracture fragments and reconstruction of the periosteal sleeve and triangular fibrocartilaginous complex are reviewed. At an average follow-up of 5.8 years, all patients were assessed for range of motion, strength, pain and function, and radiographic appearance. All had a range of motion postoperatively of at least 85% of the opposite wrist in all planes. Average grip strength was 88.6% of the contralateral wrist. Radiographic evaluation demonstrated no evidence of instability in any plane. There were no cases of subluxation of the distal ulna nor collapse of the ulnar side of the carpus. Those 7 patients studied arthrographically demonstrated an intact "water-tight" ulna-sided soft tissue sling, and all distal radius fractures healed primarily.