Proximal Ulna Fractures
Fractures of the olecranon are common in adults and can be complex lesions. Triceps pull is acting as a dislocating force. The soft tissue envelope at the back of the proximal ulna is only tenuous. In fractures following direct trauma, accompanying soft tissue lesions are common. Combined with swelling by fracture hematoma and oedema, skin closure can be challenging. Bulky implants increase the risk of wound healing issues. As another factor, fracture configuration and bone quality play an important role in fixing these lesions. While conservative treatment has been advocated only for low demand patients, non-comminuted simple fractures are amenable to cerclage techniques. With figure of eight cerclages, strong fixation is feasible. However, the procedure should not be seen as a particularly easy procedure. Misplacement of the wires may lead to failure of the construct. Incomplete burial of the cerclage locks may lead to iatrogenic complications with wound healing. The comminuted fractures should be fixed using osteosynthesis plates. On the market, different types of plates are available. Standard 3.5 LCP can help to stabilize uncomminuted distal olecranon fractures. The comminuted fractures of the proximal portion of the olecranon demand specific features of the plates, so that the sometimes small proximal fragment can securely be stabilized with as many screws as possible. As a new concept, double plating of the olecranon is being done with one plate at the medial aspect of the olecranon and a second one on the lateral aspect. In that way, the plates can be hidden under the anconeus muscle laterally and the flexor carpi ulnaris muscle medially. By that, optimal soft tissue management is possible. Whether double plating of the olecranon is of significant benefit will be investigated by clinical studies in the future.
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