Proximal ulnar fractures and dislocations

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Abstract

Purpose of review

Recent advances in the treatment and classification of fractures of the proximal ulna will be reviewed, with an emphasis on injury patterns rather than on fracture locations.

Recent findings

For the terrible triad injury, a protocol has been created that addresses all bony and soft tissue injuries, recognizing that the lateral collateral ligament complex rarely remains intact. The coronoid process is also repaired, and new data emphasize the role of the coronoid in varus stability. Recent work has also shown that the type of coronoid fracture can to a great extent be predicted by the mechanism of injury. Varus overload results in medial facet fractures, posterior dislocations result in coronoid tip fractures, and trans-olecranon fracture-dislocations result in large coronoid base fractures. Some attention has also been paid to defining the trans-olecranon fracture-dislocation as a distinct entity from Monteggia lesions. Results with trans-olecranon fractures have been poor despite aggressive surgical management, particularly with concomitant radial head or neck injuries.

Summary

The recognition of specific injury patterns involving fractures of the proximal ulna has led to advances in the management and classification of these injuries.

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