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Ulna / Ulnar Shaft Fracture

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a href="/image4/ulna1.jpg">img src="/image4/ulna1a.jpg" alt=""/>/a> a href="/image4/ulna2.jpg">img src="/image4/ulna2a.jpg" alt=""/>/a> a href="/image4/ulna3.jpg">img src="/image4/ulna3a.jpg" alt=""/>/a>br/>
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- See:br/>
      - a href="/bones/radius-ulna/adult-both-bone-forearm-frx/">Both Bone Forearm Fracture:/a> / a href="/orthopaedics/ulnar-styloid-process-frx/">Ulnar Styloid/a> Processbr/>
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strong>- Anatomy:/strong>br/>
     - radius & ulna lie parallel to each other when forearm is supinated;br/>
     - during pronation radius crosses ulna, rotating on axis that passes from capitulum through the distal end of ulna;br/>
     - ular side of wrist is supported by a href="/muscles-tendons/triangular-fibrocartilage-complex/">TFCC/a>, which articulates w/ both lunate and a href="/joints/wrist/triquetrium/">triquetrium;/a>br/>
     - ulnar attachment of a href="/muscles-tendons/triangular-fibrocartilage-complex/">TFC/a> is to base of a href="/orthopaedics/ulnar-styloid-process-frx/">ulnar styloid/a> & distally to triquetrum w/ volar ulnocarpal a href="/joints/wrist/ligaments-of-the-wrist/">ligaments;/a>br/>
     - a href="/bones/hand/interosseous-membrane/">interosseous membrane/a>:br/>
            - radius and ulna are joined by proximal & distal a href="/joints/distal-radial-ulnar-joint/">RU joints/a> & by interosseous membrane, which is directed obliquely downward from radius to ulna;br/>
            - since ulna does not articulate w/ carpi, direction of interosseous membrane is important in transmission of longitudinal forces from radius to ulna;br/>
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strong>- Radiographs:/strong>br/>
     - in the child, it is essential to have 3 views of the elbow: (AP, lateral, and oblique) before a a href="/trauma-fractures/monteggias-fracture/">Monteggia frx/a> can be ruled out;br/>
           - this is especially true in proximal ulnar shaft frx;br/>
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strong>- a href="/trauma-fractures/pediatric-ulnar-fracture/">Pediatric Ulnar Fracture:/a>/strong>br/>
    - a href="/trauma-fractures/pediatric-both-bone-forearm-fractures/">Pediatric Both Bone Forearm Fractures/a>br/>
    - a href="/trauma-fractures/monteggias-fracture/">Monteggia's Fracture/a>br/>
    - a href="/trauma-fractures/green-stick-frx-of-forearm/">Green Stick Frx/a>br/>
    - a href="/arthritis/rheumatoid-factor/">Distal Ulnar Physeal Fractures/a>br/>
    - references:br/>
           - a href="http://www.ncbi.nlm.nih.gov/pubmed/2723051" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Plastic deformation in pediatric fractures: Mechanisms and treatment/a>.  br/>
           - a href="http://www.ncbi.nlm.nih.gov/pubmed/6467729" ref="linkpos=1&log$=citationsensor" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Traumatic plastic deformation of the radius and ulna. A closed method of correction of deformity./a>br/>
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a href="/image4/i1/nght1.jpg">img align="right" src="/image4/i1/nght1a.jpg" alt=""/>/a> br/>
strong>- Adult Ulna Shaft Fracture:/strong> br/>
    - night stick fracture: mechanism: direct trauma w/ forearm used to block blowbr/>
    - strong>stable frx:/strong>br/>
          - diplaced < 50% = Stable;br/>
          - periosteum & a href="/bones/hand/interosseous-membrane/">interosseous membrane/a> are intact & act as restraint to rotation;br/>
    - strong>unstable fracture:/strong>br/>
          - displaced > 50% or > 10-15 deg angulation;br/>
          - angulation or displacement towards the interosseous membrane is poorly tolerated;      br/>
          - periosteum and a href="/bones/hand/interosseous-membrane/">interosseous membrane/a> disrupted;br/>
          - associated injuries: radial head frx or dislocation (see a href="/trauma-fractures/monteggias-fracture/">Montegga frx/a>)br/>
    - strong>non operative treatment:/strong>br/>
          - 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;br/>
          - well fitted forearm cast or brace which does not interfere with wrist or elbow motion;br/>
          - expect 50% reduction of forearm pronation or supination while in the brace;br/>
          - references:br/>
                  - a href="http://www.ncbi.nlm.nih.gov/pubmed/1002752" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Treatment of ulnar fractures by functional bracing/a>.br/>
                  - a href="http://www.ncbi.nlm.nih.gov/pubmed/6826596" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">The isolated fracture of the ulnar shaft. Treatment without immobilization/a>.br/>
                  - a href="http://www.ncbi.nlm.nih.gov/pubmed/8027895" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Bracing of stable shaft fractures of the ulna/a>.    br/>
                  - a href="http://www.ncbi.nlm.nih.gov/pubmed/2750495" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Early mobilization of isolated ulnar-shaft fractures/a>.br/>
                  - a href="http://www.ncbi.nlm.nih.gov/pubmed/1527129" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Isolated ulnar shaft fractures. Comparison of treatment by a functional brace and long-arm cast/a>.br/>
                  - a href="http://www.ncbi.nlm.nih.gov/pubmed/3581571" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Treatment of isolated ulnar shaft fractures with prefabricated functional fracture braces/a>.br/>
                  - a href="http://www.ncbi.nlm.nih.gov/pubmed/23814249">A systematic review of the non-operative treatment of nightstick fractures of the ulna/a>br/>
                  - a href="http://www.ncbi.nlm.nih.gov/pubmed/25843885">Results of 70 consecutive ulnar nightstick fractures/a>.br/>
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    - strong>surgical options:/strong>br/>
          - see: a href="/orthopaedics/surgical-approach-to-the-ulna/">approach to the ulna/a> and a href="/trauma-fractures/plates-for-fracture-repair/">plating techniques/a>;br/>
          - a href="/bones/tibia-fibula/open-fractures/">open fractures/a>: (see a href="/bones/tibia-fibula/gustilo-classification-of-open-tibial-frxs/">Gustillo classification/a>)br/>
          - open fractures should be treated as an emergency, but fixation may be delayed upto 24 hrs;br/>
                 - immediate ORIF in grade I, II, and IIIa fractures can have good results (low infection rate);br/>
                 - autogenous bone grafting can be carried out early for grade I and II fractures (if needed);br/>
                 - grade IIIb and IIIc fractures had poor results;br/>
                         - these fractures were serially debrided until judged clean, only at which time was bone grafting performed;br/>
                         - despite these measures, infections may occur in upto 3/4 of these patients;br/>
                         - wound closurebr/>
                         - 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;br/>
                                 - 2 days of antibiotics should follow each wound debridement;br/>
                         - consider a href="/joints/hip/addition-of-antibiotics-to-cement/">antibiotic bead pouch/a> between debridements;br/>
          - strong>references:/strong>br/>
                 - a href="http://www.ncbi.nlm.nih.gov/pubmed/3745238" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Immediate internal fixation of open fractures of the diaphysis of the forearm/a>.br/>
                 - a href="http://www.ncbi.nlm.nih.gov/pubmed/9258828" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" ref="ordinalpos=1&ncbi_uid=9258828&link_uid=9258828&linksrc=docsum_title">The necessity of acute bone grafting in diaphyseal forearm fractures: a retrospective review./a>br/>
                 - a href="http://www.ncbi.nlm.nih.gov/pubmed/6725352" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">The treatment of isolated fractures of the distal ulna/a>.br/>
                 - a href="http://www.ncbi.nlm.nih.gov/pubmed/2402989" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Isolated ulnar shaft fractures. Retrospective study of 46 cases/a>.br/>
                 - a href="http://www.ncbi.nlm.nih.gov/pubmed/7263044" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Non-union of the isolated fracture of the ulnar shaft in adults/a>.br/>
                 - a href="http://www.ncbi.nlm.nih.gov/pubmed/2750495" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Early mobilization of isolated ulnar-shaft fractures/a>.br/>
                 - a href="http://www.ncbi.nlm.nih.gov/pubmed/1527129" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Isolated ulnar shaft fractures. Comparison of treatment by a functional brace and long-arm cast/a>.br/>
                 - a href="http://www.ncbi.nlm.nih.gov/pubmed/3581571" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Treatment of isolated ulnar shaft fractures with prefabricated functional fracture braces/a>.br/>
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    - strong>frx complications:/strong> a href="/image4/i1/nght2.jpg">img align="right" src="/image4/i1/nght2a.jpg" alt=""/>/a>br/>
          - non union: approx: 5%;br/>
          - a href="/bones/hand/ulnocarpal-impingement-syndrome/">ulnar carpal abutment/a>:br/>
          - references:br/>
                 - a href="http://www.ncbi.nlm.nih.gov/pubmed/7263044" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Non-union of the isolated fracture of the ulnar shaft in adults/a>.br/>
                 - a href="http://www.ncbi.nlm.nih.gov/pubmed/12671511" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Atrophic nonunions of the proximal ulna./a>br/>
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a href="http://www.ncbi.nlm.nih.gov/pubmed/6725352" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">The treatment of isolated fractures of the distal ulna/a>.br/>
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a href="http://www.ncbi.nlm.nih.gov/pubmed/2402989" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Isolated ulnar shaft fractures. Retrospective study of 46 cases/a>.br/>
br/>
a href="http://www.ncbi.nlm.nih.gov/pubmed/1395274" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Internal fixation of ulnar fractures by locking nail/a>.br/>
br/>
a href="http://www.ncbi.nlm.nih.gov/pubmed/7586820" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false">Soft tissue attachments of the ulnar coronoid process. An anatomic study with radiographic correlation/a>./div>br/>hr/>br/>br/>br/>Last updated by Clifford R. Wheeless, III, MD on Saturday, April 11, 2015 9:02 pmbr/>

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