PMC6746158_01
Imaging findings. Plain radiography (a) and computed tomography (b) images show transverse fracture at the proximal ulna. Plain radiographs immediately after open reduction with internal fixation (c) and at three months thereafter (d).
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A lateral radiograph of the left forearm upon presentation revealed a transverse fracture at the posterolateral aspect of the proximal ulna (Figure 1(a)). Computed tomography of the left ulna showed cortical thickening, with transverse fractures and spike formation on the volar side (Figure 1(b)). The fracture was diagnosed as atypical, and bisphosphonate therapy was stopped. The patient underwent open reduction with internal fixation (ORIF) using a 3.5 mm locking compression plate (DePuy Synthes, Zeist, Netherlands) for the ulnar fracture (Figure 1(c)). Plain radiography showed no signs of fracture healing at three months postoperatively (Figure 1(d)), when the patient complained of pain at the fracture site.
Findings of plain radiography after reoperation. Immediately after the second operation (a). Two months after the second operation, bone absorption is evident (b). The gap at the fracture site has decreased in 19 months after reoperation (c), and bone union is complete at 30 months after reoperation (d).
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An autologous corticocancellous bone graft from the iliac crest was inserted at the resection site, and osteosynthesis was proceeded using a locking plate indicated for olecranon fractures (DePuy Synthes, Zeist, Netherlands) (Figure 2(a)). However, a callus was not observed, and bony absorption was visible at the bone graft site at two months after the reoperation (Figure 2(b)). After 19 months on teriparatide, X-rays revealed bone bridges and a decreased gap between the fragments (Figure 2(c)). Healing after 30 months of treatment with LIPUS and teriparatide was complete (Figure 2(d)), and this coincided with the disappearance of pain and a complete range of elbow and wrist joint motion.