Using autograft in the surgical treatment of isolated distal ulna fractures with open reduction internal fixation improves short-term clinical outcomes: 11 years of experience - 10/10/21

Doi : 10.1016/j.otsr.2021.103082

Mirza Zafer Dagtas ^⁎ , Omer Kays Unal
Maltepe University Medical Faculty, Department of Orthopedics and Traumatology, Istanbul, Maltepe, Turkey

^⁎Corresponding author.

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Highlights

•	Pseudoarthrosis development was significantly more common in the ORIF group.
•	Compared to ORIF, the time to union was significantly shorter with the autograft+ORIF.
•	Autograft+ORIF group had significantly higher MAYO score and grip strength.
•	Autograft+ORIF group had significantly lower DASH score, compared to the ORIF group.

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Abstract

Background

Most of the studies on ulna fractures assess the treatment of fractures accompanied by other tissue injuries; thus, the number of studies focused directly on isolated distal ulna fractures are very few. In this study, it was aimed to evaluate the short-term results of open reduction internal fixation (ORIF) and autograft+ORIF approaches in the treatment of isolated distal ulna fractures.

Hypothesis

Using autograft in the surgical treatment of isolated distal ulna fractures with open reduction internal fixation improves short-term clinical outcomes.

Patients and methods

The records of isolated distal ulna fractures (distal one-third) operated at the Maltepe University Hospital Orthopedics and Traumatology Clinic between January 2009 and December 2019 were retrospectively reviewed. The cases were divided into two groups according to surgical approach, ORIF (n=40) or autograft+ORIF (n=34).

Results

The mean age was 41.55±12.42 years. 52.7% of the cases were female, 67.6% of the fractures were right-sided, and 37.8% of the traumas causing the fracture were high-energy trauma. There was no significant difference between the ORIF and autograft+ORIF groups in terms of age, gender, side and severity of trauma (p>0.05). It was found that pseudoarthrosis development was significantly more prevalent in the ORIF group (25%) compared to the autograft+ORIF group (5.9%) (p=0.026). The median (1st quartile–3rd quartile) time to union was 16 (14–17) weeks in the ORIF group, and 9.5 (8.5–12) weeks in the autograft+ORIF group. Compared to ORIF, the time to union was significantly shorter with the autograft+ORIF procedure (p<0.001). At both the 3rd and 12th month follow-up examinations, the autograft+ORIF group was found to have significantly higher MAYO score and grip strength, and lower DASH score, compared to the ORIF group.

Discussion

When an autograft is used in addition to ORIF in the surgical treatment of isolated distal ulna fractures, the bone heals faster, pseudoarthrosis develops less frequently, and short-term (3rd and 12th months) functional results are better.