Proximal Ulna fractures are fairly common elbow injuries. There are two main types: olecranon fractures and coronoid fractures. Unfortunately, both types of proximal ulnar fractures frequently require surgical management.
Non-displaced olecranon fractures (cracks in the bone without separation of the fragments) are fairly uncommon in adults, but are more common in children. Non-displaced olecranon fractures usually do well with 3 weeks of casting followed by protective use and physical therapy.
Displaced olecranon fractures, where the fragments have separated over 2 mm, require surgery in order to restore elbow function. The triceps tendon, the only tendon that extends your elbow, attaches to the olecranon. Failure to fix the olecranon means that triceps function will be permanently compromised. Olecranon fractures may also disrupt the elbow joint and lead to arthritis. All of these problems are minimized by surgical treatment. There are many fixation devices that can be used to treat olecranon fractures, but I believe that specially-designed locking plates are currently the best fixation available. These plates have a low complication rate and are stable enough to allow for early motion. Olecranon fractures usually do very well following surgical fixation. For an illustration of a plated olecranon fracture, please see the elbow fracture section of this website.
Coronoid fractures are rarely isolated injuries to the elbow. Coronoid fractures are usually associated with other elbow fractures and ligament injuries. Coronoid fractures can be an important part of very serious elbow injuries, such as the ‘terrible triad’ injury, which involves fractures of the coronoid, fracture of the radial head, and a tear of the lateral collateral ligament. These and other complex injury patterns usually require operative fixation to have the best chance of future function.
These complex injury patterns do best in the hands of subspecialists, with the advanced training and experience to understand these injury patterns and treat them. I have extensive experience with these injuries, and most patients I’ve treated have had very good outcomes. I’ve also lectured on these injury patterns and performed research on the optimal way to fix large coronoid fractures. If the coronoid fracture is small it is usually fixed by suture. If it’s large, it is usually fixed with a special plate; often a screw is added for additional stability. For an illustration of a plated coronoid fracture, please see the elbow fracture section of this website.
While these are serious injuries, in the hands of an experienced elbow surgeon with a committed postoperative rehabilitation effort by the patient, the surgical results are usually excellent.