What is the treatment for a non-displaced ulnar fracture?

Treatment for Non-Displaced Ulnar Fracture

Non-displaced ulnar fractures should be treated with rigid immobilization using a short arm cast with the wrist in neutral position for 3-6 weeks, followed by progressive rehabilitation exercises. 1

Initial Management

• Immobilization Options:

  • First-line: Short arm cast with wrist in neutral position for 3-6 weeks 1
  • Alternative: Removable splint for minimally displaced fractures 1

• Pain Management:

  • Ice application during first 3-5 days for symptomatic relief 1
  • Consider multimodal pain management protocols 1

• Early Rehabilitation:

  • Begin active finger motion exercises immediately after diagnosis to prevent stiffness 1
  • Avoid excessive immobilization which may lead to stiffness and reduced range of motion 1

Diagnostic Considerations

• Initial imaging should include standard radiographs to confirm diagnosis 2
• If initial imaging is negative but clinical suspicion remains, consider:
  • Splinting
  • Repeat radiography in 7-14 days 2

Treatment Algorithm Based on Fracture Type

1. Isolated Non-Displaced Ulnar Shaft Fracture (Nightstick Fracture):

   • Can be effectively managed with conservative treatment 2
   • Research suggests that brief immobilization (≤2 weeks) followed by early mobilization may reduce healing time to an average of 6.7 weeks compared to prolonged immobilization (10.5 weeks) 3

2. Non-Displaced Ulnar Styloid Fracture:

   • Conservative management with immobilization is recommended 1
   • Surgical fixation is generally not required 1
   • Note: Non-union of ulnar styloid fractures is common but typically does not affect functional outcomes 1, 4, 5

Follow-up Care

• Radiographic Follow-up:

  • Recommended at 3 weeks and at cessation of immobilization 1
  • Evaluate for signs of malunion or delayed union

• Post-Immobilization Rehabilitation:

  • Progressive range of motion exercises 1
  • Gradual return to activities 1
  • Directed home exercise program 1
  • Progressive weight-bearing exercises as tolerated 1
  • Strengthening exercises 1

Potential Complications

• Inadequate immobilization may lead to malunion or delayed union 1
• Excessive immobilization may lead to stiffness and reduced range of motion 1
• All patients with unremitting pain during follow-up should be reevaluated 1

Important Considerations

• Low-intensity pulsed ultrasonography (LIPUS) should NOT be used as it does not accelerate healing or lower rates of nonunion 1
• For combined fractures involving both the ulna and radius, surgical correction is generally required 2
• For ulnar styloid fractures associated with distal radius fractures, the presence of the ulnar styloid fracture typically does not affect clinical outcomes when the distal radioulnar joint (DRUJ) is stable 4, 5