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Proximal ulna non-union: treatment concept and postoperative outcome

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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.

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Authors and Affiliations

  1. Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt Am Main, Frankfurt am Main, Germany

    Tim Jakobi, Yves Gramlich, Matthias Sauter, Sebastian Fischer, Reinhard Hoffmann & Alexander Klug

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  1. Tim Jakobi
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  2. Yves Gramlich
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  3. Matthias Sauter
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  4. Sebastian Fischer
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Contributions

Tim Jakobi: Conceptualized and designed the study, Examined the patients, Analyzed and interpreted the data, Performed the statistical analysis, Wrote and revised the manuscript.

Yves Gramlich: Proofread the manuscript, Analyzed the data.

Matthias Sauter: Proofread the manuscript, Analyzed the data.

Sebastian Fischer: Proofread the manuscript, Analyzed the data.

Reinhard Hoffmann: Proofread the manuscript, Conceived and designed the study, Provided administrative, technical, and material support.

Alexander Klug: Proofread the manuscript, Reviewed the literature, Analyzed the data, Provided administrative, technical, and material support.

Corresponding author

Correspondence to Tim Jakobi.

Ethics declarations

Ethics approval and consent to participate

The study has been approved by the Ethical Committee of the Regional Medical board of Hessen, Germany (under study ID 2020–1906-evBO). All investigations were conducted in conformity with the principles of good clinical practice and the ethical principles of research.

Informed consent was obtained from all individual participants included in the study.

Consent for publication

There is no individual participant data in our manuscript.

Competing interests

The authors declare no competing interests.

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Jakobi, T., Gramlich, Y., Sauter, M. et al. Proximal ulna non-union: treatment concept and postoperative outcome. International Orthopaedics (SICOT) 46, 2859–2868 (2022). https://doi.org/10.1007/s00264-022-05577-w

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  • DOI: https://doi.org/10.1007/s00264-022-05577-w

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