Proximal Ulna Fractures
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Proximal Ulna Fractures
- 1. Proximal Ulna Fractures Adam C Watts Consultant Elbow and Upper Limb Surgeon, Wrightington Hospital Visiting Professor, Manchester University 1
- 18. www.wrightington.com Minimising complication / re-operation 18 Anatomical reduction Bicortical penetration Subchondral placement Patient selection Fracture personality Bone quality
- 19. www.wrightington.com Alternatives Dorsal plating (30% re-operation v 50% with TBW) Parallel plating Intramedullary device Suture repair 19
- 24. www.wrightington.com Indications Simple transverse or stable oblique fractures Osteotomy Very proximal fractures 24
- 36. Isolated Olecranon Fracture www.wrightington.com 37 Super elderly / Low demand? Dementia? Unfit? Non-operative Is ulnohumeral joint stable? Simple transverse/ stable oblique Suture repair Comminuted YES NO Plate Fixation (+/- suture repair)
- 37. www.wrightington.com 38 Transolecranon Monteggia Fracture Dislocations Proximal ulna fracture with dislocation of radial head from radiocapitellar joint and proximal radioulnar joint
- 38. www.wrightington.com Bado Classification Anterior Posterior Lateral Radial diaphyseal fracture 39
- 39. www.wrightington.com Jupiter Classification of Type II Fractures IIa Coronoid level IIb Metaphyseal/ Diaphyseal junction IIc Distal to coronoid IId Fracture extending to distal 1/2 ulna 40
- 40. www.wrightington.com Ring Classification Type I Apex anterior diaphyseal ulna fracture with anterolateral dislocation of radiocapitellar and PRUJ Type II Metaphyseal buckle fractures with anterolateral radiocapitellar dislocation (paediatric only) Type III Apex posterior ulna fractures with posterior dislocation radiocapitellar joint 41
- 41. www.wrightington.com Aims of treatment Restoration of normal ulna alignment Restoration of elbow stability coronoid buttress radial head lateral ligament complex 42
- 42. www.wrightington.com Bado I, Ring I 43
- 45. www.wrightington.com Jupiter IIb, Ring III 46
- 51. www.wrightington.com Complication Fixation failure - osteoporosis common Ulna non-union Ulno-humeral instability Radio-ulna synostosis 54
- 60. www.wrightington.com 63 Outcome Monteggia Fractures Anterior (Bado I, Ring I) good outcomes less likely to involve radial head or coronoid Posterior (Bado II, Ring III) poor worse if unstable coronoid fracture present (Jupiter IIa) coronoid / radial head fractures and re-operation associated with poorer outcome.
- 61. www.wrightington.com 64 Summary Tension band wiring > 50% re-operation Newer techniques reduce secondary surgery Ulna alignment and coronoid key to success in Monteggia fractures