Challenges in Healing: Right Ulnar Fracture and Radial Head Dislocation

Right ulnar fracture with radial head dislocation, postoperative nonunion?

Dear Dr.
Chen,
I sustained an injury while attending a meeting on February 10 of this year, resulting in an open fracture: a fracture of the right ulnar bone accompanied by a dislocation of the radial head, as well as a contusion of the left ankle with ligament tears.
I underwent emergency surgery where two titanium alloy plates and six screws were implanted in the ulnar bone.
Throughout the year, I have been advised by orthopedic and rehabilitation specialists to actively rest and rehabilitate.
As of December 29, I have passed over 10 months, with seven follow-up visits to the orthopedic clinic.
Recent X-ray examinations show that the fracture healing is slow and not yet complete.
I have also undergone osteoporosis testing, which showed no abnormalities.
The doctor has suggested further observation for about two months, and if healing remains poor, surgical intervention may be necessary to perform a bone graft and replace the screws.
I would like to ask Dr.
Chen, although I do not experience significant pain, there are no neurological abnormalities, and my finger function is intact, I find that I am mostly unable to exert force or lift moderately heavy objects with my forearm.
The sensations I experience are primarily muscle tightness and similar to muscle soreness.
Is this issue related to the fracture, or could it be a problem with the nerves or muscles? Are there any methods to promote bone development and healing? I have been following the doctor's instructions for rest and calcium supplementation.
Is the slow and poor healing truly an indication that I need another surgery? Given that the bone has already healed poorly, wouldn’t another surgery increase the risk? As a female, could my age be contributing to issues with bone resorption and recovery? Should I undergo any additional examinations? Thank you for your selfless dedication in providing answers that help me in this difficult situation.

e.e, 40~49 year old female. Ask Date: 2017/12/29

Dr. Chen Yongxue reply Orthopedics

1.
The described unusual sensation is likely primarily related to a bone issue.

2.
To promote bone development and healing, immobilization is essential in the initial phase, and calcium supplementation is also very important.
Additionally, there are reports that ultrasound may improve healing, but it has not received unanimous support.
If the condition persists beyond nine months, bone graft surgery should be considered.

3.
Since the bone has already healed poorly, wouldn't undergoing surgery pose additional risks? ==> There are risks, but it may be the most effective solution.

4.
There are many reasons for nonunion of fractures, such as infection, inadequate stabilization, or severe injury (which may be your case).
It is advisable to discuss this with your attending physician.
Thank you.

Reply Date: 2017/12/29

More Info

It sounds like you have been through a challenging recovery process following your right ulnar fracture and radial head dislocation. Given the complexity of your injuries and the prolonged healing time, it's understandable to have concerns about your recovery and the potential need for further surgical intervention.

From your description, it seems that you have undergone significant treatment, including surgery to stabilize the fracture with titanium plates and screws. The fact that you have had multiple follow-up appointments and imaging studies indicates that your orthopedic team is closely monitoring your progress. The slow healing of the fracture site, despite the absence of pain and normal nerve function, raises several considerations.

Firstly, the healing process for bone fractures can vary significantly among individuals. Factors such as age, overall health, nutritional status, and the nature of the fracture itself can all influence healing. In your case, since you mentioned that you are a female and possibly of an age where bone density may be a concern, it is important to consider whether osteoporosis or other metabolic bone diseases could be affecting your healing. Although your osteoporosis screening came back normal, it may be worthwhile to discuss with your physician whether additional tests, such as a DEXA scan, could provide more insight into your bone health.

Regarding your current symptoms of muscle tightness and difficulty lifting weights, these could be attributed to several factors. While the fracture may not be healing as expected, the surrounding soft tissues, including muscles and ligaments, may also be contributing to your discomfort and functional limitations. Muscle tightness can occur due to disuse or compensatory patterns developed during your recovery. Engaging in physical therapy focused on strengthening and improving the range of motion may be beneficial. A physical therapist can provide tailored exercises to help restore function and alleviate tightness.

As for the possibility of needing further surgery, your orthopedic surgeon's recommendation to observe for an additional two months is a prudent approach. If the fracture site continues to show signs of non-union or delayed healing, surgical intervention may be necessary to promote healing, such as bone grafting or the replacement of hardware. While surgery does carry risks, it may also be the best option to ensure proper healing and restore function in your arm.

In terms of promoting bone healing, there are several strategies you can consider. Adequate nutrition is crucial; ensure you are consuming enough calcium and vitamin D, as these nutrients are essential for bone health. Additionally, engaging in weight-bearing exercises, as tolerated, can help stimulate bone growth. However, it is essential to follow your physician's advice regarding activity levels to avoid exacerbating your condition.

Lastly, maintaining open communication with your healthcare team is vital. If you have concerns about your recovery or the need for further intervention, do not hesitate to express these to your orthopedic surgeon. They can provide you with the most accurate information based on your specific situation and help you make informed decisions about your treatment plan.

In summary, while your current symptoms may be related to the healing of your fracture, they could also stem from muscle tightness or compensatory patterns. Continuing to follow your physician's recommendations, engaging in physical therapy, and ensuring proper nutrition will be key to your recovery. If healing does not progress as expected, further evaluation and potential surgical options may be necessary.

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