Abstract
Purpose: To analyze the clinical and demographic presentation, treatment strategies, and outcomes of athletes who sustained proximal ulna stress injuries and elucidate the available evidence on management and anatomic variation. Methods: A literature search was performed on the basis of the medical databases MEDLINE/PubMed and Embase. Articles reporting on sports-related physeal injuries and stress fractures of the proximal ulna were eligible for inclusion. Outcome variables included clinical presentation, imaging assessments, management, and complications. Results: A total of 40 studies were included with 174 athletes who sustained physeal injuries or stress fractures of the proximal ulna. The age ranges of the 74 patients with physeal injuries and 100 patients with stress fractures were 11-26 years and 14-30 years, respectively. Of the studies reporting on clinical symptoms, athletes most commonly presented with olecranon tenderness to palpation and swelling. All athletes with physeal injuries were diagnosed with plain radiographs, whereas 47 athletes who underwent radiography for olecranon stress fractures required additional advanced imaging. Studies on nonoperative management reported return to play rates from 67% to 100% (median, 100% [interquartile range, 100-100%]) and 2 complications were reported (chondromalacia of the trochlear notch and occasional symptomology). One hundred twenty-six patients were treated operatively, of which failure of conservative management was reported in 15 of 40 studies, including 61 athletes. The return to play rates ranged from 67% to 100% (median, 100% [interquartile range, 100-100%]) and 20 complications were reported, most commonly hardware irritation (n = 15). Conclusions: Proximal ulna stress injuries in athletes can be managed either nonoperatively or operatively, with both showing satisfactory rates of return to play. Although operative management was more common, almost one half of these athletes failed an initial trial of nonoperative management. Level of Evidence: Level IV, systematic review of Level III-IV studies.
| Original language | English |
|---|---|
| Article number | 101019 |
| Pages (from-to) | 1-14 |
| Number of pages | 14 |
| Journal | Arthroscopy, Sports Medicine, and Rehabilitation |
| Volume | 7 |
| Issue number | 1 |
| Early online date | 9 Oct 2024 |
| DOIs | |
| Publication status | Published - Feb 2025 |
Bibliographical note
Publisher Copyright:© 2024 The Authors
Funding
MB declares research and fellowship support from Smith and Nephew (Watford, England). TL declares being a consultant for DePuy Synthes (Warsaw, Indiana) and honoraria from the Arbeitsgemeinschaft fur Osteosynthesefragen (AO) group. The other authors certify that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. This article did not receive any funding. Not related to this article, HK reports receipt of support by De Stichting Prof. Micha\u00EBl-van Vloten Fonds (the Hague, the Netherlands), Van Leersum Grant / KNAW Medical Sciences Fund from the Royal Netherlands Academy of Arts & Sciences (Amsterdam, the Netherlands), Marti-Keuning Eckhardt Foundation (Amsterdam, the Netherlands), Vreedefonds (Amsterdam, the Netherlands), the Stichting Anna Fonds | NOREF (Mijdrecht, the Netherlands), the Stichting het Scholten-Cordes Fonds (the Hague, the Netherlands), Fundatie van Renswoude (\u2018s-Gravenhage, the Netherlands), and the USC Scholarship Foundation (Utrecht, the Netherlands). NA reports receipt of support from Vreedefonds (Amsterdam, the Netherlands) and Hendrik Mullerfonds (the Hague, the Netherlands). The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: M.P.J.v.d.B. reports funding grants from Smith & Nephew. T.V.L. reports consulting or advisory for DePuy Synthes and speaking and lecture fees from the AO Foundation.