Management of a Five-Decades-Old Nonunion of the Ulna: A Rare Case Report

Abstract

Introduction: Chronic nonunion of fractures, especially of long-duration standing, is challenging to manage. The nonunion of forearm bones is now often effectively treated with open reduction and internal fixation using a plate. Case report: A 71-year-old male was presented with a nonunion of the ulna following the fractures of radius and ulna, 51 years ago, which was treated with open reduction and internal fixation, using square nails. Later, an attempt to remove the broken ulnar nail was successful partially. Now, the patient presented with stiffness and decreased range of motion of the elbow and wrist joints, along with features of ulnar nerve palsy. We managed this case by open reduction and internal fixation of the ulna fractures, removal of broken square nail and bone grafting. Additionally, anterior ulnar nerve transposition was done. This treatment resulted in fracture union and neurological improvement. Conclusion: This rare case is the longest nonunion ever reported. It demonstrates the complexity of managing long-standing nonunions, through a combined approach of providing mechanical stability and biological augmentation.

Keywords

• fracture fixation
• non union
• ulna fractures
• elbow
• treatment outcomes