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Proximal ulna fractures are common injuries in the upper extremity. The severity of injury ranges from isolated olecranon fractures to complex elbow fracture dislocations. Relevant anatomic features of the proximal ulna for fracture management are presented in the first part of this article. Furthermore, standard and recent techniques of surgical treatment are described in detail for olecranon and Monteggia fractures as well as for fractures of the coronoid process. Functional outcome and complications of fracture treatment are discussed., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Differentiation between malignant bone tumors and tumor-like lesions after repetitive microtrauma following sport activities can be difficult just using radiographic methods., Methods: We present the case of a fifteen year old karate fighter, who was examined by imaging diagnostics because of a progressive swelling and pain in the distal right forearm., Results: A tumor-like appearance with bone mass formation in the x-ray, an enhancement in the surrounding tissue shown in the MRI and an increased activity in the bone scintigraphy made the diagnosis of an osteosarcoma very likely. Blood tests were not helpful. Only the evaluation of a bone biopsy could demonstrate hypertrophic reparative bone formation after multiple osseous microtrauma. Cast immobilisation reduced the osseous alteration. With the start of the training the swelling reappeared again but then finally vanished after modifying the training technique., Discussion: The case demonstrates that even modern imaging techniques cannot always distinguish between tumor and tumor-like lesions caused by sports. It also stresses the importance of a correct technique in sports like karate.

An exact knowledge of the value of different pictorial diagnostic techniques allows a focussed and rapid diagnosis of ulnar wrist pain. A prerequisite for the choice of the best possible method of investigation is an exact clinical examination. The basic examination involves conventional recording at both the centralised at the symptomatic levels. If there is a suspicion of occult bone lesion, finely focused, magnified graphics, CT or bone scintigraphy should be used, depending on both the problem faced and availability. For tissue or ligament lesions, stress graphics, movement studies or MRT, also with contrast media, should be used. Bone scintigraphy is a suitable method to differentiate between inflammatory tissue and/or bone changes.

The distal radioulnar joint (DRUJ), the ulnocarpal joint and the ulnar carpus form an functional anatomical complex, as the head of the ulna is an articulated part of DRUJ as well as having a stabilising action and acting as an abutment due to its direct attachment to the triangular fibrocartilage complex. Pain in this area poses a diagnostic problem due to the close proximity of these structures. In addition to describing the standard clinical examination, the major pathologies of these ulnar hand components, their symptomatology and the basis of their therapy are discussed.

We present a case of a 27 year old I. gravida, I. para. Despite of regular ultrasonographic examination the diagnosis of skeletal malformation at the fetus was not before 33. weeks of gestation. It was the rare type of a bothside femur-fibula-ulna (FFU) complex. The FFU-complex is a no lethal malformation with typical unilateral combination from defects of femur and fibula, with contralateral defect of ulna. Dependent to involvement of malformated limbs the FFU-complex is classifiable in four groups. Only in 10 % all limbs are affected. Our case (type IV) showed a peromelia of both upper limbs with stumps of humeri, bothside aplasia of fibula and missing from 4. and 5. toes. There fetus were without nonlimb congenital abnormalities. The etiology of FFU-complex is unknown, the occurrence sporadic. There are never found genetic abnormalities. Familial recurrence is not described. There is no maternal or paternal age effect on FFU-complex. The differential diagnosis must include malformations with reduction anomalies of extremities, like thalidomide syndrome, splenogonadal fusion with limb malformations, Roberts syndrome, oroacral complex or acheiropodia. Mark off are amniotic band too.

We investigated 20 patients suffering from wrist pain accompanied by local swelling of the recessus ulnaris. Pain could be produced by direct pressure to the recessus ulnaris or by rotation of the forearm during prehension grip. One group (n = 14) had no previous operation or trauma. A second group (n = 6) had undergone previous surgery or suffered from trauma. All patients were treated by injection of cortisone and lidocaine into the recessus ulnaris. In the first group, ten (71%) remained pain-free during a period of 19 (9 to 40) months. In the second group, no improvement could be achieved. Based on anatomy and evolution of the recessus ulnaris, we try to establish a theory of the pathology.

This case report describes a stress fracture of the ulna in a 26-year-old professional table-tennis player. X-ray films remained negative so that the diagnostic is based on MRT. This stress fracture is caused by changing the intensity of training and changing the table-tennis-racket.

Variations in length ratios of both radius and ulna directly influence the profiles of the distal radioulnar joint. During pronation and supination, joint surface incongruity of the two forearm bones permits rotational and translational movements. The ulnocarpal discuss is the central part of the ulnocarpal complex. Together with radioulnar and ulnocarpal ligaments, the ulnocarpal meniscus, the tendon sheath of the extensor carpi ulnaris muscle, the ulnar collateral ligament, and accessory fiber strands the complex guides movements such as pronation and supination and stabilizes the proximal and distal carpal joint.

Bone changes of the upper extremity are rare manifestations of the M. Paget disease. Most frequently the disease affects the lower extremities, the pelvis followed by the calvarium and others. The rare asymptomatic, monostotic manifestation of Paget's disease of the left proximal ulnae of a 59 year old woman and the way of diagnosis is described. Symptomatic skeletal lesions are detected by radiological examination, bone scintigraphy reveals asymptomatic lesions. Laboratory tests (Alkaline serum phosphatase, Hydroxyproline in urine) monitor the activity of the disease.

Arthrography of the proximal wrist joint does not provide details regarding the shape and the extension of the recessus ulnaris. The recessus located between the ulnocarpal disc and the meniscus homologue as a diverticulum of the articular lining was examined in 61 wrists by arthrography and dissection. Using the Pleximon-injection technique, specimens of the proximal wrist cavity allowed a systematic description of morphology and topography of the ulnar recessus. The shape and location of the ulnar recessus show variations, but a sacciform recessus, which usually bears a close relationship to the ulnar styloid process, is the most common. The comparison of arthrographic and morphologic findings allows an assessment of the credibility of arthrographic depictions of the wrist as regards the clinically relevant close relationship to the recessus ulnaris.

Premature closure of the distal ulnar physis leads to medial bowing of the radius, later to lateral deviation of the carpus, and ventral subluxation of the elbow. Diagnosis of this growth disturbance depends on accurate radiographical examination. There are different surgical treatments to allow the radius to grow without impediment. The prognosis depends on early treatment.

Morphologic and biomechanical changes are often the causes of osteoarthrosis in a joint. Complete integrity is necessary, if a joint will be intact the whole life. This integrity is very often disturbed in the distal radio-ulnar joint by trauma and also by surgical treatment. To avoid any incongruence in this joint, which seemed to be neglected by surgeons and orthopaedics, in 1985 about 700 wrists were examined by X-ray, to study the exact morphology with regard to the relation between ulna, radius, declinations and lengths. The aim was to avoid failures in future by all therapeutic procedures. 31 negative ulnar variances (4.4%) and 9 (1.4%) non-traumatic positive variances with a difference of more than 2 mm were revealed. The declination of the distal radio-ulnar joint in relation to the axis of the radius was measured by a special goniometer. To find out the three-dimensional structure of this joint, oblique X-ray photographs were also taken. The results were: in joints with negative ulnar variance declinations of 100 degrees and more were found, and the stereoscopic pictures were conical; in the presence of positive ulnar variance the declinations amounted to 80 degrees or less and the distal radio-ulnar joint surfaces were spherical; in neutral ulnar variances the angle was found to be about 90 degrees and the joints were cylindrical in form. Nearly all operative or traumatic changes were associated with incongruence of this joint. Therefore all therapeutic methods must be planned exactly with reference to this stereoscopic relations between radius and ulna. In traumatic cases the three-dimensional integrity must be reconstructed.(ABSTRACT TRUNCATED AT 250 WORDS)

In this study the morphological changes in the shape and structure of the ulna were investigated following resection of a mid-shaft segment in the radius. These morphological alterations are called in German "Martin'sche Umbauzone" (MUZ; Martin's transformation zone). Various explanations for the MUZ can be found in the literature; Wolff's law, in particular, offers hints about the development of this phenomenon. The morphological changes in the ulna were investigated by microangiography, polarized light and fluorescence microscopy as well as by micro-radiography. The radius was operated on in 36 mongrel dogs. The development and localization of new bone formation at the endosteal and periosteal envelope of the ulna were studied. The woven bone formation of the envelopes (modelling) and the intracortical remodelling in the distal part of the ulnae were compared with the intact ulnae of the opposite extremities. It is concluded from these morphological alterations that the experimental design chosen provides a valuable, tissue-related model for the investigation of morphogenesis in bones. Further investigations will deal with the correlation between strain and new bone formation.

Aggressive fibromatoses which may develop either in soft tissue or in the bone present considerable problems for the pathologist trying to establish a diagnosis as well as for the radiologist and surgeon. In radiographs, a destruction of the soft and osseous tissue is seen which suggests a malignant tumor. Histologically a monomorphic connective tissue prevails in the biopsy showing no essential signs of malignancy. Under pathoanatomical aspects often a benign proliferation of the connective tissue is assumed. Surgically the tumor may either be removed in a too radical and mutilating way, or the excision may remain incomplete. Two cases of desmoplastic bone fibroma (aggressive fibromatosis in the ulna and in the sacrum) are described in which the complete tumor removal led to healing, whereas the incomplete excision of the tumor resulted in recurrences. Aggressive fibromatosis represents a semimalignant tumor which has a locally destructive and invasive growth tendency but does not metastasize. The various fibromatoses are defined with regard to their biological growth tendency and the therapeutic consequences are discussed.

Report on 2 cases of poly-ostotic fibrous dysplasia combined with pigmented areas of the skin with secondary fibrosarcoma of the ulna or femur. They are analysed together with 49 cases published so far. The average age at the time of malignancy being diagnosed was 34.4 years. The average time from recognition of fibrous dysplasia to malignant changes was 17.7 years. In 14 cases local radiotherapy preceded the development of sarcoma. Femur and jaws were the most common sites. There were 30 osteosarcomas, 11 fibrosarcomas and 7 chondrosarcomas. The prognosis is bad: only 14 patients survived for 5 years. But malignant change is rare in fibrous dysplasia. It occurs in less than 1% of cases. Severe forms of poly-ostotic fibrous dysplasia which still progress in adults with a raised alkali phosphatase appear to show an increased tendency towards malignant degeneration.

The microstructure of the osseous ligament insertion was studied by light microscopy and scanning electron microscopy using the insertion of the membrana interossea antebrachii as an example. The scanning electron microscopical findings of specimens which had been prepared by freeze-fracturing confirm the typical 4-zone-structure of the osseous ligament insertion. The findings emphasize the functional importance of both zones of unmineralized and mineralized fibrous cartilage, which represent an effective shock absorbing system for the collagenous structures of the osseous ligament insertion.

In a right-left experiment on the ulna of beagles, the authors investigate the influence of induced alternating current on the number of healed-in autologeous spongiosa grafts taken from the same side of the body. At first an atrophic pseudarthrosis is produced in both ulnae of twenty animals by bone resection and electrocoagulation over six months. Following to spongiosa transplantation and plate osteosynthesis, the ulnae are stimulated during eight weeks with a sinusoidal current of 38 cps and an electromagnetically induced alternating-current voltage of 600 mV on an average. The blindfold evaluation of the X-ray picture is performed by four experts and shows significantly better results in the stimulated side. By variance analysis of the results of electronic planimetry of serial layers in the region of transplantation represented by microradiography, it is demonstrated that the greater bone density of the stimulated grafts compared to the control grafts is statistically significant. It has to be considered that these results refer strictly to the electric data and treatment times applied by the authors. Particularly the results are not valid for the unique application of electromagnetic fields without alternating-current component.