J Am Acad Orthop Sur
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Proximal ulna fractures can be difficult to manage because of the elbow's complex anatomy. Advances in understanding elbow anatomy and biomechanics, however, have led to new insights. Careful preoperative evaluation is critical because failure to restore normal anatomy of the proximal ulna could have a detrimental effect on postoperative elbow function. ⋯ Coronoid fractures, olecranon fractures, and associated elbow instability influence the indications for any given fixation device. Appreciating the subtleties of proximal ulna anatomy and biomechanics can lead to improved clinical outcomes. Recent concepts affecting fracture management include proximal ulna dorsal angulation, the importance of the anteromedial facet of the coronoid, and intermediate fragments of the olecranon.
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Understanding the pediatric response to polytrauma is essential for the orthopaedic surgeon. The physiologic effects of multisystem injury that manifest in a child have important implications for coordination of treatment, particularly in relation to the timing and incidence of organ failure. ⋯ Indications for surgery and postoperative immobilization in the pediatric polytrauma patient differ from those in the patient with an isolated injury. Further research is needed to determine the most appropriate method of management for extremity fractures in the pediatric polytrauma patient, particularly regarding the timing of fixation and management of open fractures.