Proximal Ulna and Radial Neck Nonunions
Lee Hunter MD, MBA
Hunter Medical Founder and Chief Medical Officer
Proximal forearm nonunions can be difficult to manage, particularly when both the radius and ulna are involved. Gross instability of the proximal forearm can complicate these procedures and make patient positioning even more important regarding simplifying and accelerating the surgical procedure.
72 YOF WITH PROXIMAL ULNA AND RADIAL NECK NONUNIONS
The patient fell from a standing height and suffered proximal ulna and radial neck fractures of her right elbow. She underwent surgery to repair her ulna fracture, as well as a later operation to remove symptomatic hardware. She presented to my office 13 months after her injury, complaining of pain, “floppiness” of her elbow and loss of use of her arm. The patient had no history of infection, labs revealed no suspicion of infection, and her clinical exam was otherwise unremarkable with healthy skin. The patient has never smoked, and is not a diabetic.
The patient was positioned supine utilizing the ElbowLOC® Arm Positioning System. A standard posterior approach was made. Fibrous scar tissue was removed from the ulna nonunion site, and several millimeters of bone resected proximally and distally to expose more healthy cancellous bone. The radial head was floating loose in the joint, was removed, and a radial head replacement inserted. An autogenous iliac crest bone graft was then inserted in the ulna nonunion site, and a plate and screw construct applied. There was no clinical suspicion of infection intraoperatively, and cultures were negative. The X-rays below are 6 weeks post op, motion is 10/130 with normal forearm rotation, and the elbow is essentially painless.
In this case, I felt the patient would be best served by revision fracture surgery. If a nonunion develops, conversion to a total elbow replacement would likely be the best option. The posterior approach and supine positioning give wonderful surgical access to the elbow region for problems such as this and terrible triads. The Reducer/Distractor component of the ElbowLOC provides support to the proximal forearm anteriorly, and in this case, prevented the ulna nonunion section from sagging and shortening during debridement, bone grafting, and stabilization of the nonunion site.
This case is another great example of how the ElbowLOC® simplifies and accelerates procedural times for many elbow surgeries and makes surgery easier for the surgeon, patient, and staff!