Contoured plating for proximal ulna nonunion: an improved technique

Twenty-one patients having proximal ulna nonunion were treated with contoured plating. The most proximal hole received an intramedullary 6.5-mm cancellous lag screw that extends fixation of the nonunion site. Mean age of the patients was 41.7 years. Average follow-up period was 22 months. Union occurred in 19 cases after a mean of 9.6 weeks. Complications were persistent nonunion in two cases, a stiff elbow in one, hardware prominence in two, and a 1 x 1-cm ulcer over the curve of the plate in one case. The two unsatisfactory results were related to ulnohumeral arthritis. In conclusion, augmentation of the contoured plate with a 6.5-mm intramedullary cancellous lag screw creates a stable construct in treatment of proximal ulna nonunion. It applies axial compression, resists bending forces on the dorsal plate and allows early mobilization after surgery, regardless of the size of the proximal fragment.