🦴 Proximal Third Ulna Fracture in an Adolescent – A Clinical Overview

🦴 Proximal Third Ulna Fracture in an Adolescent – A Clinical Overview

📸 Case Summary

This X-ray demonstrates a fracture of the proximal third of the right ulna in an adolescent patient. The fracture is displaced with an unstable pattern, suggesting a moderate to high-energy injury.

(Proximal Ulna Fracture)

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⚠️ Why This Injury Is Important

In children and adolescents, a proximal ulna fracture is rarely isolated. It is essential to always rule out an associated condition known as

👉 Monteggia fracture-dislocation

This involves:

• Fracture of the ulna

• Dislocation of the radial head at the elbow

❗ Important Note:

Missed diagnosis or inappropriate treatment (such as native oil bandaging without proper medical evaluation) can lead to long-term disability, deformity, and restricted elbow movement.

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🔍 Understanding the Radiological Landmark

(Insert Annotated Elbow X-ray Image Here – Radiocapitellar Line)

This image highlights the key radiological lines used in evaluating elbow injuries:

📌 Important Lines to Remember

• Radiocapitellar Line

A line drawn along the axis of the radius

It should always pass through the capitellum

If it does not → suspect radial head dislocation

• Anterior Humeral Line

Drawn along the anterior cortex of the humerus

Should intersect the middle third of the capitellum

Useful in assessing supracondylar fractures

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🔍 Key Radiological Assessment

👉 Orthopaedic specialist consultation is mandatory

• Evaluate fracture pattern (complete, displaced, comminuted)

• Check radiocapitellar alignment

• Assess for:

◦ Radial head dislocation

◦ Elbow joint congruity

◦ Associated neurovascular injury

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🧠 Mechanism of Injury

• Fall on outstretched hand (FOOSH)

• Direct trauma to the forearm

• Sports-related injuries

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🛠️ Management Approach

✅ If isolated, undisplaced ulna fracture:

• Conservative treatment with above-elbow slab/cast immobilization

• Regular follow-up with serial X-rays

⚠️ If displaced fracture or associated Monteggia injury:

• Urgent reduction is required

• Restoration of ulna length is the key principle

→ Radial head usually reduces automatically

• Surgical fixation (plate osteosynthesis) is recommended in unstable fractures for:

Early recovery

Better functional outcome

Early mobilization

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⏳ Possible Complications

• Missed radial head dislocation

• Malunion of ulna

• Restricted forearm rotation

• Posterior interosseous nerve (PIN) injury

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💡 Clinical Pearl

👉 “In pediatric forearm injuries, always fix the ulna first — the radius will follow.”

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🏥 Expert Care Matters

Early diagnosis and appropriate treatment ensure:

• Proper fracture healing

• Full restoration of elbow function

• Prevention of long-term deformity and disability

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By

Dr. M. Kalaivanan, MS (Ortho)

Orthopaedic Surgeon – Trichy

📲 Call/WhatsApp: +91-8122073520

🌐 https://drkalaivananorthosurgeon.com

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