Surgical outcomes after reoperation of intra-articular proximal ulna fractures

Literature on outcomes after reoperation for intra-articular proximal ulna fractures is lacking, even though reoperation rates for these fractures are reportedly one of the highest of any anatomic site, ranging from 22%-89%. This study aims to evaluate range of motion (ROM) and complication rates after reoperation for these fractures.

In this retrospective single institution cohort study, we identified 134 patients with intra-articular, comminuted fractures of the proximal ulna initially treated with open reduction internal fixation between January 2015 and March 2022. Of this cohort, 34 of the 134 patients (25%) underwent reoperation. A Wilcoxon signed-rank test was conducted to assess differences between preoperative and postoperative ROM.

Symptomatic hardware was the most common indication for reoperation (28/34 [82%]), followed by ulnar neuropathy (4/34 [12%]). ROM remained similar before and after reoperation for patients who underwent reoperation for indications other than stiffness. Patients that were reoperated for stiffness showed a 9° (P = .03) improvement in extension and 26° (P = .02) improvement for flexion. Twelve patients experienced complications, of which persistent implant irritation (3/12 [25%]) and tendinopathy (3/12 [25%]) were the most common.

In our study cohort, 25% of patients underwent reoperation-most often due to symptomatic hardware. While ROM is typically preserved after reoperation and improved when the indication for reoperation is elbow stiffness, a significant proportion of patients (35%) experience subsequent complications. Counseling patients about reoperation outcomes is essential to manage patient expectations and can help them make informed decisions. This approach supports informed decision-making and optimizes patient care.