From the Guidelines
The treatment for a minimally displaced fracture of the mid ulna (ulnar shaft) is simple immobilization, as this approach is appropriate when fracture fragments are small, nonarticular, or minimally displaced. This recommendation is based on the principles outlined in a study published in the American Family Physician 1. The goal of treatment is to ensure proper healing, maintain forearm function, and prevent long-term complications.
Key Considerations for Treatment
- Immobilization can be achieved with a long arm cast or a functional brace, depending on the specific fracture characteristics and patient needs.
- Pain management is crucial in the initial stages and can be managed with acetaminophen or NSAIDs, such as ibuprofen, as needed.
- Regular follow-up with radiographic studies is essential to monitor the fracture's alignment and healing progress.
Potential Complications and Further Intervention
- If the fracture shows signs of increased displacement or angulation, surgical intervention may be necessary to ensure proper alignment and healing.
- Physical therapy plays a critical role after immobilization to restore range of motion, strength, and function of the forearm.
Evidence-Based Decision Making
The decision to proceed with simple immobilization for a minimally displaced ulnar shaft fracture is supported by the study 1, which emphasizes the importance of conservative management for fractures with minimal displacement or fragmentation. This approach prioritizes minimizing morbidity, reducing the risk of complications, and preserving the quality of life for the patient.
From the Research
Treatment Options for Minimally Displaced Fracture of the Mid Ulna
- Immobilization is a common treatment approach for minimally displaced fractures of the mid ulna, as stated in 2.
- According to 3, stable fractures, which include minimally displaced fractures, can be managed with forearm bracing.
- A study published in 4 compared different conservative management approaches, including immediate mobilisation, below-elbow plaster cast, and above-elbow plaster cast immobilisation, and found that all methods yielded comparable results in terms of healing, time to healing, pain, and range of motion of the wrist.
- Another study 5 found that there was no significant difference in functional outcomes between operative fixation and non-operative management using a long arm cast for isolated fractures of the ulnar shaft.
Immobilization Methods
- Below-elbow plaster cast immobilisation for 6 weeks is a viable option, as reported in 4.
- Above-elbow plaster cast immobilisation for 3 weeks, followed by a below-elbow plaster cast for an additional 3 weeks, is another approach, as mentioned in 4.
- Forearm bracing can also be used to manage stable fractures, as stated in 3.
Surgical Intervention
- Open reduction and internal fixation with compression plating is a reliable treatment option for unstable fractures, according to 3.
- A study published in 6 found that surgical management using intramedullary pinning or AO plate fixation can provide good results, with minimal complications, when the technique is correct.
- However, as noted in 5, operative fixation may not result in better functional outcomes in the short term (12 months) compared to non-operative management.