Crista Supinatoris Fractures of the Proximal Part of the Ulna: Surgical Technique

INTRODUCTION: Open reduction and internal fixation of crista supinatoris fractures is required when the elbow is unstable despite appropriate nonoperative management and when a patient is undergoing surgical treatment of a periarticular elbow fracture-dislocation. STEP 1: SKIN INCISION AND SURGICAL APPROACH: Use a posterior or lateral skin incision according to your preference and then utilize the Kocher interval to access the joint, lateral collateral ligament, and crista supinatoris or, in the setting of a proximal ulnar fracture, use the Boyd interval. STEP 2: MANAGEMENT OF ASSOCIATED INJURIES: Crista supinatoris fractures have not been identified in isolation; address associated injuries such as radial head/neck fractures, capitellar fractures, and coronoid fractures first. STEP 3: EVALUATION OF ELBOW STABILITY: If elbow instability persists after the concomitant injuries have been addressed, fix the crista supinatoris. STEP 4: EXPOSURE OF THE CRISTA SUPINATORIS: Expose the fracture fragment and base of the crista supinatoris. STEP 5: REDUCTION AND FIXATION OF THE CRISTA SUPINATORIS FRACTURE: Obtain an anatomic reduction and fixation of the crista supinatoris fracture to appropriately tension the lateral ulnar collateral ligament. STEP 6: REEVALUATION OF ELBOW STABILITY: Gently evaluate the stability of the elbow following repair of the crista supinatoris fracture. STEP 7: POSTOPERATIVE CARE: Initiate rehabilitation on the basis of intraoperative stability and concomitant injuries. RESULTS: We recently conducted a retrospective review of the outcomes of twelve patients with a fracture of the crista supinatoris. Indications Contraindications Pitfalls & Challenges