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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Ulna / Ulnar Shaft Fracture





- See:
      - Both Bone Forearm Fracture: / Ulnar Styloid Process

- Anatomy:
     - radius & ulna lie parallel to each other when forearm is supinated;
     - during pronation radius crosses ulna, rotating on axis that passes from capitulum through the distal end of ulna;
     - ular side of wrist is supported by TFCC, which articulates w/ both lunate and triquetrium;
     - ulnar attachment of TFC is to base of ulnar styloid & distally to triquetrum w/ volar ulnocarpal ligaments;
     - interosseous membrane:
            - radius and ulna are joined by proximal & distal RU joints & by interosseous membrane, which is directed obliquely downward from radius to ulna;
            - since ulna does not articulate w/ carpi, direction of interosseous membrane is important in transmission of longitudinal forces from radius to ulna;

- Radiographs:
     - in the child, it is essential to have 3 views of the elbow: (AP, lateral, and oblique) before a Monteggia frx can be ruled out;
           - this is especially true in proximal ulnar shaft frx;



- Pediatric Ulnar Fracture:
    - Pediatric Both Bone Forearm Fractures
    - Monteggia's Fracture
    - Green Stick Frx
    - Distal Ulnar Physeal Fractures
    - references:
          - Plastic deformation in pediatric fractures: Mechanisms and treatment.  
          - Traumatic plastic deformation of the radius and ulna. A closed method of correction of deformity.



- Adult Ulna Shaft Fracture:
    - night stick fracture: mechanism: direct trauma w/ forearm used to block blow
    - stable frx:
          - diplaced < 50% = Stable;
          - periosteum & interosseous membrane are intact & act as restraint to rotation;
    - unstable fracture:
          - displaced > 50% or > 10-15 deg angulation;
          - angulation or displacement towards the interosseous membrane is poorly tolerated;      
          - periosteum and interosseous membrane disrupted;
          - associated injuries: radial head frx or dislocation (see Montegga frx)
    - non operative treatment:
          - indicated for fractures in the distal 2/3 of the forearm with less than 10-15 deg angulation and more than 50% to 75% fracture opposition;
          - well fitted forearm cast or brace which does not interfere with wrist or elbow motion;
          - expect 50% reduction of forearm pronation or supination while in the brace;
          - references:
                  - Treatment of ulnar fractures by functional bracing.
                  - The isolated fracture of the ulnar shaft. Treatment without immobilization.
                  - Bracing of stable shaft fractures of the ulna.    
                  - Early mobilization of isolated ulnar-shaft fractures.
                  - Isolated ulnar shaft fractures. Comparison of treatment by a functional brace and long-arm cast.
                  - Treatment of isolated ulnar shaft fractures with prefabricated functional fracture braces.
                  - A systematic review of the non-operative treatment of nightstick fractures of the ulna

    - surgical options:
          - see: approach to the ulna and plating techniques;
          - open fractures: (see Gustillo classification)
          - open fractures should be treated as an emergency, but fixation may be delayed upto 24 hrs;
                 - immediate ORIF in grade I, II, and IIIa fractures can have good results (low infection rate);
                 - autogenous bone grafting can be carried out early for grade I and II fractures (if needed);
                 - grade IIIb and IIIc fractures had poor results;
                         - these fractures were serially debrided until judged clean, only at which time was bone grafting performed;
                         - despite these measures, infections may occur in upto 3/4 of these patients;
                         - wound closure
                         - some surgeons will close surgical incisions, where as, traumatic wounds are left open and are closed by delayed suture at a second or third look debridement;
                                 - 2 days of antibiotics should follow each wound debridement;
                         - consider antibiotic bead pouch between debridements;
          - references:
                 - Immediate internal fixation of open fractures of the diaphysis of the forearm.
                 - The necessity of acute bone grafting in diaphyseal forearm fractures: a retrospective review.
                 - The treatment of isolated fractures of the distal ulna.
                 - Isolated ulnar shaft fractures. Retrospective study of 46 cases.
                 - Non-union of the isolated fracture of the ulnar shaft in adults.
                 - Early mobilization of isolated ulnar-shaft fractures.
                 - Isolated ulnar shaft fractures. Comparison of treatment by a functional brace and long-arm cast.
                 - Treatment of isolated ulnar shaft fractures with prefabricated functional fracture braces.

    - frx complications:
          - non union: approx: 5%;
          - ulnar carpal abutment:
          - references:
                 - Non-union of the isolated fracture of the ulnar shaft in adults.
                 - Atrophic nonunions of the proximal ulna.



The treatment of isolated fractures of the distal ulna.

Isolated ulnar shaft fractures. Retrospective study of 46 cases.

Internal fixation of ulnar fractures by locking nail.

Soft tissue attachments of the ulnar coronoid process. An anatomic study with radiographic correlation.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, July 9, 2013 9:21 am