Surgical outcomes after reoperation of intra-articular proximal ulna fractures.

BACKGROUND

Literature on outcomes after reoperation for intra-articular proximal ulna fractures is lacking, even though reoperation rates for these fractures are reportedly one of the highest of any anatomic site, ranging from 22%-89%. This study aims to evaluate range of motion (ROM) and complication rates after reoperation for these fractures.

METHODS

In this retrospective single institution cohort study, we identified 134 patients with intra-articular, comminuted fractures of the proximal ulna initially treated with open reduction internal fixation between January 2015 and March 2022. Of this cohort, 34 of the 134 patients (25%) underwent reoperation. A Wilcoxon signed-rank test was conducted to assess differences between preoperative and postoperative ROM.

RESULTS

Symptomatic hardware was the most common indication for reoperation (28/34 [82%]), followed by ulnar neuropathy (4/34 [12%]). ROM remained similar before and after reoperation for patients who underwent reoperation for indications other than stiffness. Patients that were reoperated for stiffness showed a 9° (P = .03) improvement in extension and 26° (P = .02) improvement for flexion. Twelve patients experienced complications, of which persistent implant irritation (3/12 [25%]) and tendinopathy (3/12 [25%]) were the most common.

CONCLUSION

In our study cohort, 25% of patients underwent reoperation-most often due to symptomatic hardware. While ROM is typically preserved after reoperation and improved when the indication for reoperation is elbow stiffness, a significant proportion of patients (35%) experience subsequent complications. Counseling patients about reoperation outcomes is essential to manage patient expectations and can help them make informed decisions. This approach supports informed decision-making and optimizes patient care.