Similar Rates of Return to Play After Operative and Nonoperative Management of Physeal Nonunions and Stress Fractures of the Proximal Ulna in Athletes: A Systematic Review of 174 Patients.

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.