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.

中文翻译：

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尺骨近端骨不连：治疗理念和术后结果

目的

尺骨近端骨不连是鹰嘴骨折和复杂肘部骨折手术治疗后的严重并发症，通常会导致功能预后不良。迄今为止，缺乏关于手术翻修后最佳治疗策略和功能结果参数的数据。

方法

从 02/2010 到 12/2018，可以包括 31 名接受手术治疗尺骨近端骨不连的患者。随访期为七年（标准差 2.5 年）。使用临床评估工具集和标准肘部评分（MEPS、OES、DASH 评分）对所有患者进行临床评估。记录了所有并发症和计划外的翻修手术，并分析了所有射线照相材料。

结果

初始骨不连手术在指数手术后平均 6.6 个月（标准差 3 个月）时进行。其中包括在所有患者中使用自体海绵体移植物，并在 28 名患者中同时进行加压再骨缝合术。所有患者均实现放射学巩固。总体而言，患者获得了良好至一般的功能结果，Mayo 肘部性能评分为 78.5 (SD 9.1)，DASH 评分为 34.7 (SD 14.4)，Oxford 肘部评分为 31.2 (SD 6.6) 分。初始复位不良/种植体位置不正可被确定为发生骨不连的主要原因。^{此外，在 > 60 岁和 BMI > 30 kg/m 2}的患者中检测到较差的术后结果。

结论

使用标准化协议，可以在近端尺骨骨不连中实现骨性愈合和可接受的功能结果。然而，外科医生应该意识到潜在的风险因素和适当的初始骨折复位是实现充分骨愈合的关键。