Background: The incidence and injury patterns of open fractures of the proximal ulna are poorly elucidated and little evidence exists to guide management. Questions/purposes: The purpose of this study was to compare the (1) bony injury patterns; (2) range of motion (ROM) and frequency of union; and (3) postoperative complications between open and closed fractures of the proximal ulna. Methods: Seventy-nine consecutive open fractures of the proximal ulna were identified. After excluding fracture-dislocations, penetrating injuries, and pediatric injuries, 60 were compared in a retrospective case-control study with an age- and sex-matched group of 91 closed fractures to compare the bony injury patterns based on radiographic review. In a subset of 39 open and 39 closed fractures with sufficient followup, chart and radiographic review was performed by someone other than the operating surgeon to compare differences in final ROM, union, and postoperative complication rates at a minimum followup of 3 months (mean, 22 and 15 months; range, 3-86 months and 3-51 months for open and closed fractures, respectively). A total of 12% of the fractures were open (79 of 671) at the three study centers, and the majority of fractures were intraarticular (45 of 60 [75%]) with Gustilo-Anderson Type I and II wounds (54 of 60 [90%]). Results: Overall, open fractures of the proximal ulna overall did not have more complex bony injury patterns, but there were more anterior olecranon fracture-dislocations among the open fracture group (nine of 60 [15%] versus two of 91 [2%]; p = 0.004) and more posterior olecranon fracture-dislocations in the closed fracture group (31 of 91 [34%] versus seven of 60 [12%]; p = 0.002). Final ROM was not different in both groups and all fractures healed. There was no difference in wound infection rate but a higher secondary procedure rate among open fractures of the proximal ulna (39% versus 23%, p = 0.014). Conclusions: In contrast to open fractures of the distal humerus, open fractures of the proximal ulna present with mild soft tissue injuries and do not have more complex bony injury patterns than closed fractures. Our findings suggest that open fractures of the proximal ulna are the result of tension failure of the skin secondary to the limited soft tissue envelope around the proximal ulna. Open fractures of the proximal ulna should be regarded as relatively mild injuries that are not different in severity and prognosis compared with closed fractures. Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence
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机译：背景：尺骨近端开放性骨折的发生率和损伤方式尚不清楚，几乎没有证据可指导治疗。问题/目的：这项研究的目的是比较（1）骨损伤模式; （2）运动范围（ROM）和结合频率; （3）尺骨近端开放性和闭合性骨折之间的术后并发症。方法：确定尺骨近端连续开放性骨折79例。在排除骨折脱位，穿通性损伤和小儿损伤后，在一项回顾性病例对照研究中，对年龄和性别相匹配的91例闭合性骨折进行了60例比较，以根据影像学检查比较骨损伤的类型。在39例开放性骨折和39例闭合性骨折的子集中，进行了充分的随访，由手术外科医生以外的其他人进行了图表检查和X线照片检查，以比较至少3个月的最终ROM，合并和术后并发症发生率的差异（平均， 22和15个月;开放性和闭合性骨折分别为3-86个月和3-51个月）。在三个研究中心中，共有12％的骨折为开放性骨折（671个中的79个），大多数骨折为关节内骨折（45个中的60个[75％]），其中包括Gustilo-Anderson I型和II型伤口（54个中的54个） [90％]）。结果：总体而言，尺骨近端的开放性骨折总体上没有更复杂的骨损伤模式，但是开放性骨折组中鹰嘴前骨骨折脱位的发生率更高（60例中有15例[15％]，而91例中有2例[2％]）。 ; p = 0.004）和闭合性骨折组中鹰嘴后部骨折脱位较多（91例中有31例[34％]，而60例中有7例[12％]; p = 0.002）。两组的最终ROM均无差异，所有骨折均愈合。在尺骨近端开放性骨折中，伤口感染率没有差异，但是次要手术率更高（39％对23％，p = 0.014）。结论：与肱骨远端开放性骨折相反，尺骨近端开放性骨折表现为轻度软组织损伤，没有比闭合性骨折更复杂的骨损伤方式。我们的发现表明，尺骨近端开放性骨折是尺骨近端周围有限的软组织包膜继发的皮肤张力衰竭的结果。尺骨近端开放性骨折应被视为相对轻度的损伤，与闭合性骨折相比，其严重程度和预后没有差异。证据级别：III级，治疗研究。有关证据水平的完整说明，请参见《作者指南》
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