Lee Hunter MD, MBA (Hunter Medical Founder and Chief Medical Officer)

October 2019

This is an unusual case of a symptomatic olecranon nonunion with a chronic ulna collateral ligament tear in a college student.

21 YO RHDM UCL Tear and Olecranon Nonunion

The patient sustained an olecranon fracture 4 years ago. He did not return for his ﬁnal X-ray to confirm healing. Over the years, he felt some chronic activity-related elbow pain but was able to pitch and perform other sports with only occasional NSAIDS. Six months prior to presentation, he felt a painful snap in his elbow while throwing during intramural sports. Since then, he’s been unable to throw hard and has developed regular aching and a sense of weakness in the medial elbow. His exam revealed full range of motion to the shoulder, elbow and wrist. He had point tenderness at the olecranon and along the course of the UCL particularly at the sublime tubercle, a positive milking test, and pain and apprehension with a dynamic valgus stress test. His current X-rays and MRI are below. The patient requested surgical intervention.

Elbow UCL Reconstruction with Olecranon Nonunion(Gallery1)

The Procedure

The patient was positioned supine, utilizing the ElbowLOC and our custom hand table. A standard posterior approach was made and the triceps incised to expose the olecranon nonunion. Fortunately, the nonunion did not involve the triceps insertion. The ununited fragment was grossly loose, and was sharply excised. This wound was irrigated and closed. Thereafter, the arm was placed on the hand table, and an autogenous palmaris longus graft harvested. A standard medial approach to the UCL was performed, protecting but not exposing the ulnar nerve. The ligament had been avulsed off the sublime tubercle and had chronic, degenerative changes within the distal half. The palmaris longus graft was doubled, passed through bone tunnels in the epicondyle, and secured with a distal docking technique using fiber wire and a cortical button, reinforced with a tenodesis screw. A surgical set up photo, along with post op X-rays are shown below.

Elbow UCL Reconstruction with Olecranon Nonunion(Gallery2)

The ElbowLOC Supine Positioner used in conjunction with our custom radiolucent hand table, allows the surgeon to easily switch between posterior and anterior elbow approaches during surgical procedures. This particularly helps expedite challenging cases such as this.

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!