5 Consequently, the appropriate treatment of proximal ulna fractures still remains a challenge for the orthopaedic surgeon. 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. Thus, the surgeon carefully needs to address all aspects of the injury to allow early (active) rehabilitation and thereby prevent elbow stiffness. 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. 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. DOI: 10.1302/2058-5222.įractures 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. The postoperative rehabilitation programme should involve active elbow motion exercises without limitations as early as possible following surgery to avoid joint stiffness.Ĭite this article: EFORT Open Rev 2019 4:1-9. Radial head reconstruction or replacement is essential in Monteggia-like lesions to restore normal elbow function.
The management of olecranon fractures primarily comprises tension-band wiring in simple fractures as a valid treatment option, but modern plate techniques, especially in comminuted or osteoporotic fracture types, can reduce implant failure and potential implant-related soft tissue irritation.įor Monteggia injuries, the accurate anatomical restoration of ulnar alignment and dimensions is crucial to adjust the radiocapitellar joint.Ĭaution is advised if the anteromedial facet (anatomical insertion of the medial collateral ligament) of the coronoid process is affected, to avoid posteromedial instability.
In complex fracture patterns a computerized tomography scan is essential to properly assess the injury severity.Įxact preoperative planning for the surgical approach is vital to adequately address all fracture parts (base coronoid fragments first). coronoid process, radial head, collateral ligament complex). Fractures of the proximal ulna range from simple olecranon fractures to complex Monteggia fractures or Monteggia-like lesions involving damage to stabilizing key structures of the elbow (i.e.
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