Nonunion of an Ulnar Neck Fracture

Indications

Delayed or nonhealing of a neck fracture following nonoperative treatment
Failed fixation with nonunion following operative treatment

Pitfall

A significant bone defect is typically present after removing the sclerotic margins of the bone and the previously placed hardware. To avoid excessively shortening the ulna it is usually necessary to place intercalary, tricortical iliac crest bone graft.

Pearl

To re-create the appropriate ulnar variance take PA projection of the contralateral wrist with the forearm pronated.

Figure 15-1

Technique

The distal ulna is exposed through a curvilinear incision extending from the base of the fifth metacarpal to the extensor carpi ulnaris (ECU), ~2 cm proximal to the distal radioulnar joint (DRUJ) (Fig. 15-1A,B).
Expose the dorsal aspect of the ulnar head and neck through the fifth extensor compartment.
Expose the ulnar aspect of the ulna in the interval between the ECU and flexor carpi ulnaris (FCU). If possible, avoid opening the ECU tendon sheath.
Remove the sclerotic margin of the nonunion with a micro oscillating or sagittal saw. Irrigate generously to avoid burning the bone.
Harvest a tricortical iliac crest graft large enough to span the defect.