[Complex fractures of the proximal end of the radius and ulna in adults: a retrospective study of 38 cases].
OBJECTIVE
Complex lesions of the proximal end of the radius and ulna are uncommon and generally associate a fracture of the proximal ulna and a dislocation of the radial head, which also may be fractured. We assessed the effect of the type of fracture and treatment on functional outcome and complications.


METHODS
Thirty-eight adults (25 men and 13 women) were treated for complex fractures of the proximal end of the radius and ulna. For 25 of them, mean follow-up was 2.4 years. For the ulna, there was an epiphyseal fracture in 10 cases, a metaphyseal-epiphyseal fracture in 16 and a diaphyseal fracture in 12. The coronoid process was fractured in 20 cases and the proximal radius in 19. There was an anterior displacement in 24 cases. There were 9 open fractures and 13 patients had another injury of the upper limb. Functional outcome was assessed with a 100 point scale using subjective (pain) and objective (active motion, muscle force, stability) criteria.


RESULTS
For the 25 fractures with more than 1 year follow-up, outcome was very good in 8, good in 6, fair in 8 and poor in 3. The pain and muscle force scores followed a similar pattern. Motion appeared as the determining factor for good outcome. Seven early revisions (2 for deep infections, 2 for disassembly of the fixation system, 3 for insufficient fixation) were required among the 38 patients. Among the late complications, there were 3 nonunions, 5 misalignments, and 4 proximal radio-ulnar synostoses. Six elbows required revision to restore motion.


CONCLUSIONS
Certain characteristics of the fractures were predictive of poor outcome: skin opening, association with a lesion of the homolateral upper limb, mirror lesion of the lateral condyle, metaphyseal-epiphyseal fractures, communitive fractures, presence of a fracture of the radial head or the coronoid process.


CONCLUSIONS
Complex proximal fractures of both bones of the forearm threaten the functional prognosis of the upper limb due to the risk of stiffness. Successful treatment depends on three factors: stable anatomic reconstruction of the ulnar articulation, and reconstruction of the lateral column and the coronoid process, necessary for a stable elbow. In addition, early mobilization, possible with a stable osteosynthesis, is indispensable for recovering useful joint movement.
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Service de Chirurgie Orthopédique et Traumatologique, Hôpital Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre Cedex, France.
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018483:Diaphyses / Q000293:injuries; D004838:Epiphyses / Q000293:injuries; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D011379:Prognosis; D011859:Radiography; D011885:Radius Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery