U. Heim, COMBINED FRACTURES OF THE UPPER END OF TH E ULNA AND THE RADIUS IN ADULTS - A SERIES OF 120 CASES, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur, 84(2), 1998, pp. 142-153
Purpose of the study The purpose of this study was to increase the kno
wledge about these rare and serious injuries and to produce guidelines
for a more successful ORIF. Material 120 cases of combined fractures
in adults with late results (minimum one year) stored in the AO Docume
ntation-Center between 1979 and 1989 were analyzed. Monotrauma was dom
inant, additional injuries were rare. No vasculo-nervous lesions were
reported. 15 fractures were open. For the ulna 4 fractures types were
isolated, fractures of the coronoid process and the radial head (CP) 2
5 cases. Olecranon and radial head fracture (OR) 22 cases. Combination
of anterior (coronoid) and posterior (olecranon) ulnar fracture with
radial head fracture (COR) 41 cases. Metaphyseal ulnar and radial head
fractures (MR) 32 cases. For the radial head we have distinguished pa
rtial (61) and complete (59) fractures, the latter including 14 neck f
ractures. Results In the CR type indirect fixation technique was never
perfect. Best results were obtained after ORIF of partial radial frac
tures. After resection, arthrosis (8/11) and valgus (8/11) were very f
requent. In the OR type the stability was restored in simple fractures
by the tension band technique even when the radial head was resected.
In the severe COR type good results were rare. Arthrosis was importan
t and frequent (36/41) especially after radial head resection. In the
MR type ORIF of the radial head combined with ulnar plating gave the b
est results. Ulnar union was delayed or missing in 13 cases especially
after radial head resection. Functional results after one year were b
etter than expected on X-rays. This was due to immediate ORIF (92/120)
and early mobilization. There were only 3 infections and 2 reflex-dys
trophies. Discussion The Coronoid is the key-fragment of the ulna. It
is best reduced in CR-Type under vision by an anterior approach. In Co
p-lesions its reduction should be the first step of ulnar ORIF. Commin
utions in OR, COR and MR-Types showed a high number of delayed or non
union. The reason may be a biological weakness (reduced vascularizatio
n) in these areas. Therefore we advocate for bridging plates land canc
ellous grafts) for the stabilization of such areas, especially for the
metaphysis where a strong valgus force appears after radial resection
. Radial head as the lateral pillar of the elbow should be restored by
ORIF in partial fractures (excellent results) and even in complete fr
actures (5/10 excellent results) under favourable conditions. Prosthes
is is indicated in severe radial comminution or serious ulnar instabil
ity.