Fractures of the Olecranon and Complex Fracture–Dislocations of the Proximal Ulna and Radial Head

Chapter 15 discusses radius and ulna trauma. Forearm fractures are common and may be isolated to the ulna or more commonly involve both bones. Fractures of the radius or ulna are usually because of direct trauma and are often displaced. Depending on their complexity, isolated fractures of the ulnar diaphysis may be treated nonoperatively or operatively whereas both bone (radius and ulna) diaphyseal fractures are typically treated operatively. Galeazzi fracture-dislocations are comprised of radial diaphyseal fractures in association with distal radioulnar joint (DRUJ) dislocation/subluxation. Monteggia fracture-dislocations are comprised of a proximal ulnar fracture in association with radial head dislocation. In type IV Monteggia injuries, there is an additional fracture of the proximal radial diaphysis. Essex-Lopresti fracture-dislocations include radial head fractures in association with DRUJ dislocation/subluxation.

Download Full-text

Radial head fractures

Shoulder & Elbow ◽

10.1177/1758573219876921 ◽

2019 ◽

Vol 12 (3) ◽

pp. 212-223 ◽

Cited By ~ 1

Author(s):

RP van Riet ◽

MPJ van den Bekerom ◽

A Van Tongel ◽

C Spross ◽

R Barco ◽

...

Keyword(s):

Radial Head ◽

Long Term Results ◽

Valgus Stress ◽

Proximal Ulna ◽

Radial Head Fractures ◽

Radial Head Arthroplasty ◽

Radial Head Replacement ◽

Treatment Type ◽

Radial Head Resection ◽

Type 3

The shape and size of the radial head is highly variable but correlates to the contralateral side. The radial head is a secondary stabilizer to valgus stress and provides lateral stability. The modified Mason–Hotchkiss classification is the most commonly used and describes three types, depending on the number of fragments and their displacement. Type 1 fractures are typically treated conservatively. Surgical reduction and fixation are recommended for type 2 fractures, if there is a mechanical block to motion. This can be done arthroscopically or open. Controversy exists for two-part fractures with >2 mm and <5 mm displacement, without a mechanical bloc as good results have been published with conservative treatment. Type 3 fractures are often treated with radial head replacement. Although radial head resection is also an option as long-term results have been shown to be favourable. Radial head arthroplasty is recommended in type 3 fractures with ligamentous injury or proximal ulna fractures. Failure of primary radial head replacement may be due to several factors. Identification of the cause of failure is essential. Failed radial head arthroplasty can be treated by implant removal alone, interposition arthroplasty, revision radial head replacement either as a single stage or two-stage procedure.

Download Full-text

Reconstruction Techniques for Fractures of the Proximal Ulna and Radial Head

Essential Techniques in Elbow Surgery ◽

10.1007/978-3-319-31575-1_5 ◽

2016 ◽

pp. 59-86

Author(s):

James M. McLean ◽

George S. Athwal ◽

Parham Daneshvar

Keyword(s):

Radial Head ◽

Proximal Ulna

Download Full-text

Vitallium radial head prosthesis for acute and chronic elbow fractures and fracture-dislocations involving the radial head

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2005.09.010 ◽

2006 ◽

Vol 15 (4) ◽

pp. 463-473 ◽

Cited By ~ 41

Author(s):

Cary B. Chapman ◽

Brian W. Su ◽

Stefano M. Sinicropi ◽

Roderick Bruno ◽

Robert J. Strauch ◽

...

Keyword(s):

Radial Head ◽

Radial Head Prosthesis ◽

Elbow Fractures ◽

Fracture Dislocations

Download Full-text

Fractures of the proximal ulna: current concepts in surgical management

EFORT Open Reviews ◽

10.1302/2058-5241.4.180022 ◽

2019 ◽

Vol 4 (1) ◽

pp. 1-9 ◽

Cited By ~ 7

Author(s):

Sebastian Siebenlist ◽

Arne Buchholz ◽

Karl F. Braun

Keyword(s):

Radial Head ◽

Injury Severity ◽

Joint Stiffness ◽

Coronoid Process ◽

Collateral Ligament ◽

Postoperative Rehabilitation ◽

Proximal Ulna ◽

Elbow Function ◽

Fracture Types ◽

Olecranon Fractures

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. coronoid process, radial head, collateral ligament complex). In complex fracture patterns a computerized tomography scan is essential to properly assess the injury severity. Exact preoperative planning for the surgical approach is vital to adequately address all fracture parts (base coronoid fragments first). 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. For Monteggia injuries, the accurate anatomical restoration of ulnar alignment and dimensions is crucial to adjust the radiocapitellar joint. Caution is advised if the anteromedial facet (anatomical insertion of the medial collateral ligament) of the coronoid process is affected, to avoid posteromedial instability. Radial head reconstruction or replacement is essential in Monteggia-like lesions to restore normal elbow function. The postoperative rehabilitation programme should involve active elbow motion exercises without limitations as early as possible following surgery to avoid joint stiffness. Cite this article: EFORT Open Rev 2019;4:1-9. DOI: 10.1302/2058-5241.4.180022.

Download Full-text

Fractures of the Olecranon and Complex Fracture–Dislocations of the Proximal Ulna and Radial Head