CURRENT CONCEPTS IN ADULTS UPPER EXTREMITY FRACTURES

21452Ugur_TiftikciCurrent_Consept_in_adults.kapak

CONSERVATIVE TREATMENTOF PROXIMAL ULNA FRACTURES

Ali Aydilek1 Begüm Aslantaş Kaplan2

1Univesitiy of Health Sciences, Ankara Gülhane Training and Research Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye
2Univesitiy of Health Sciences, Ankara Gülhane Training and Research Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye

Aydilek A, Aslantaş Kaplan B. Conservative Treatment of Proximal Ulna Fractures. In: Tiftikçi U, Erdoğan E, Ergün C, Güneş Z, editors. Current Concepts in Adults Upper Extremity Fractures. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.167-174.

ABSTRACT

Proximal ulna fractures, affecting the olecranon, coronoid process, and adjacent joint structures, are frequently encountered in orthopaedic trauma. While surgical treatment is often prioritized for displaced or unstable fractures, recent studies emphasize the efficacy of conservative management, particularly in non-displaced fractures or in elderly patients with comorbidities. Conservative approaches, including immobilization and gradual mobilization, have demonstrated favourable outcomes without the risks associated with surgical interventions.

This review focuses on the criteria that support conservative treatment, such as fracture classification, joint stability, and patient-specific factors. Evidence suggests that in carefully selected cases, non-operative management can provide excellent functional recovery, particularly in elderly patients, challenging the assumption that surgery is the default treatment for proximal ulna fractures. These findings underline the importance of considering conservative treatment as a first-line option in appropriate clinical scenarios.

Keywords: Conservative treatment; Proximal ulna; Fractures

Referanslar

  1. Duckworth AD, Clement ND, Aitken SA, Court-Brown CM, McQueen MM. The epidemiology of fractures of the proximal ulna. Injury. 2012;43(3):343-346. [Crossref]  [PubMed]
  2. Veillette CJ, Steinmann SP. Olecranon fractures. Orthop Clin North Am. 2008;39(2):229-vii. [Crossref]  [PubMed]
  3. Karlsson MK, et al. Fractures of the olecranon: a 15to 25-year followup of 73 patients. Clin Orthop Relat Res, 2002(403):205-12. [Crossref]
  4. Anderson ML, Larson AN, Merten SM, Steinmann SP. Congruent elbow plate fixation of olecranon fractures. J Orthop Trauma. 2007;21(6):386-393. [Crossref]  [PubMed]
  5. Rommens PM, Küchle R, Schneider RU, Reuter M. Olecranon fractures in adults: factors influencing outcome. Injury. 2004;35(11):1149-1157. [Crossref]  [PubMed]
  6. Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. Instr Course Lect. 1995;44:175-185. [Crossref]  [PubMed]
  7. Chen MJ, Campbell ST, Finlay AK, Duckworth AD, Bishop JA, Gardner MJ. Surgical and Nonoperative Management of Olecranon Fractures in the Elderly: A Systematic Review and Meta-Analysis. J Orthop Trauma. 2021;35(1):10-16. [Crossref]  [PubMed]
  8. Duckworth AD, Clement ND, McEachan JE, White TO, Court-Brown CM, McQueen MM. Prospective randomised Aydilek, Aslantaş Kaplan Conservative Treatment of Proximal Ulna Fractures trial of non-operative versus operative management of olecranon fractures in the elderly. Bone Joint J. 2017;99B(7):964-972.1112.R2. [Crossref]  [PubMed]
  9. Marot V, Bayle-Iniguez X, Cavaignac E, Bonnevialle N, Mansat P, Murgier J. Results of non-operative treatment of olecranon fracture in over 75-year-olds. Orthop Traumatol Surg Res. 2018;104(1):79-82. [Crossref]  [PubMed]
  10. Putnam MD, Christophersen CM, Adams JE. Pilot report: non-operative treatment of Mayo Type II olecranon fractures in any-age adult patient. Shoulder Elbow. 2017;9(4):285-291. [Crossref]  [PubMed]  [PMC]
  11. Steinmann SP. Coronoid process fracture. J Am Acad Orthop Surg. 2008;16(9):519-529. [Crossref]  [PubMed]
  12. Regan W, Morrey B. Fractures of the coronoid process of the ulna. J Bone Joint Surg Am. 1989;71(9):1348-1354. [Crossref]  [PubMed]
  13. O'Driscoll SW, Jupiter JB, Cohen MS, Ring D, McKee MD. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect. 2003;52:113-134.
  14. Selesnick FH, Dolitsky B, Haskell SS. Fracture of the coronoid process requiring open reduction with internal fixation. A case report. J Bone Joint Surg Am. 1984;66(8):1304-1306. [Crossref]  [PubMed]
  15. Morrey BF. The elbow and its disorders. 3rd ed. Philadelphia, PA: W.B. Saunders Company; 2000.
  16. Baltassat, A., Baldairon, F., Berthe, S., Bellier, A., Bahlouli, N., & Clavert, P. (2024). Creation of a replicable anatomic model of terrible triad of the elbow. Journal of Orthopaedic Surgery and Research, 19(1), 638. [Crossref]  [PubMed]  [PMC]
  17. De Klerk HH, Ring D, Boerboom L, Van Den Bekerom MPJ, Doornberg JN. Coronoid fractures and traumatic elbow instability. JSES Int. 2023;7(6):2587-2593. [Crossref]  [PubMed]  [PMC]
  18. Chan K, Faber KJ, King GJW, Athwal GS. Selected anteromedial coronoid fractures can be treated nonoperatively. J Shoulder Elbow Surg. 2016;25:1251-7. [Crossref]  [PubMed]
  19. Moon J-G, Bither N, Jeon Y-J, Oh S-M. Non surgically managed anteromedial coronoid fractures in posteromedial rotatory instability: three cases with 2 years follow-up. Arch Orthop Trauma Surg. 2013;133:1665-8. [Crossref]  [PubMed]
  20. Rhyou IH, Kim KC, Lee J-H, Kim SY. Strategic approach to O'Driscoll type 2 anteromedial coronoid facet fracture. J Shoulder Elbow Surg. 2014;23:924-32. [Crossref]  [PubMed]
  21. Lee H-D, Jung Y-J, Oh J-K, Moon J-G. Morphological characteristics of fractures of the anteromedial facet of the coronoid in posteromedial rotatory instability of the elbow: a three-dimensional CT remodeling study. J Shoulder Elbow Surg. 2021;30:1527-36. [Crossref]  [PubMed]
  22. Morrey BF, An KN. Stability of the elbow: osseous constraints. J Shoulder Elbow Surg. 2005;14(1 Suppl S):174S178S. [Crossref]  [PubMed]
  23. Giannatos V, Antzoulas P, Charalampus H, Athanasiou V, Panagopoulos A, Kokkalis Z. Elbow Dislocation With Associated Essex-Lopresti Injury: A Case Treated Conservatively. Cureus. 2022;14(12):e32099. Published 2022 Dec1. [Crossref]
  24. Baker M, Eyre-Brook A, Gokaraju K, et al. Non-operative management of terrible triad injuries of the elbow; not so terrible?. Shoulder Elbow. 2024;16(2):200-205. [Crossref]  [PubMed]  [PMC]
  25. Foruria AM, Gutiérrez B, Cobos J, Haeni DL, Valencia M, Calvo E. Most coronoid fractures and fracture-dislocations with no radial head involvement can be treated nonsurgically with elbow immobilization. J Shoulder Elbow Surg. 2019;28(7):1395-1405. [Crossref]  [PubMed]