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. 2022 Dec;46(12):2859-2868.
doi: 10.1007/s00264-022-05577-w. Epub 2022 Sep 14.

Proximal ulna non-union: treatment concept and postoperative outcome

Tim Jakobi  1 , Yves Gramlich  2 , Matthias Sauter  2 , Sebastian Fischer  2 , Reinhard Hoffmann  2 , Alexander Klug  2
Affiliations

Proximal ulna non-union: treatment concept and postoperative outcome

Tim Jakobi et al. Int Orthop. 2022 Dec.

Abstract

Purpose: Non-union of the proximal ulna is a serious complication after surgical treatment of olecranon and complex elbow fractures, frequently leading to poor functional outcome. To date, there is a lack of data regarding optimal treatment strategies and functional outcome parameters after surgical revision.

Methods: From 02/2010 to 12/2018, 31 patients undergoing surgical treatment of proximal ulna non-union could be included. Follow-up period was seven years (SD 2.5 years). All patients were clinically assessed using a clinical assessment tool set and standard elbow scores (MEPS, OES, DASH score). All complications and unplanned revision surgeries were recorded and all radiographic material was analyzed.

Results: Initial non-union procedures were performed at an average of 6.6 months (SD 3 months) after the index procedures. Those included the use of autologous spongiosa graft in all patients and concomitant compression re-osteosynthesis in 28 patients. Radiological consolidation was achieved in all patients. Overall, patients achieved a good to fair functional outcome with Mayo elbow performance score measuring 78.5 (SD 9.1), DASH score 34.7 (SD 14.4), and Oxford elbow score 31.2 (SD 6.6) points. Initial malreduction/implant-malposition could be identified as a main reason for the occurrence of the non-union. Furthermore, inferior postoperative outcome was detected in patients > 60 years and BMI > 30 kg/m2.

Conclusion: Using a standardized protocol, bony union and acceptable functional outcomes can be achieved in proximal ulna non-unions. However, surgeons should be aware of potential risk factors and proper initial fracture reduction as key to achieve sufficient bone healing.

Keywords: Autologous spongiosa graft; Non-union; Outcome; Proximal ulna; Re-osteosynthesis; Risk factor.

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References

    1. Boyd H, Lipinski SW, Wiley JH (1961) Observations on non-union of the shafts of the long bones, with a statistical analysis of 842 patients. J Bone Joint Surg 43(2):159–168 - DOI
    1. Rupp M, Biehl C, Budak M, Thormann U, Heiss C, Alt V (2018) Diaphyseal long bone nonunions - types, aetiology, economics, and treatment recommendations. Int Orthop 42(2):247–258. https://doi.org/10.1007/s00264-017-3734-5 - DOI - PubMed
    1. Nicholson JA, Makaram N, Simpson A, Keating JF (2021) Fracture nonunion in long bones: a literature review of risk factors and surgical management. Injury 52(2):3–11. https://doi.org/10.1016/j.injury.2020.11.029 - DOI
    1. Papagelopoulos PJ, Morrey BF (1994) Treatment of nonunion of olecranon fractures. J Bone Joint Surg Br 76(4):627–635 - DOI - PubMed
    1. Tian R, Zheng F, Zhao W, Zhang Y, Yuan J, Zhang B, Li L (2020) Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis. J Orthop Surg Res 15(1):377. https://doi.org/10.1186/s13018-020-01904-2 - DOI - PubMed - PMC

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