From the Guidelines
The primary treatment option for fractures of the ulna shaft is surgical intervention, particularly for displaced or unstable fractures, while non-displaced fractures can be managed with immobilization. The diagnosis of ulnar shaft fractures is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies 1. For non-displaced isolated ulnar shaft fractures, treatment consists of immobilization, which is appropriate when fracture fragments are small, nonarticular, or minimally displaced 1.
Key Considerations
- Fracture characteristics, such as displacement and stability, guide the treatment approach
- Non-displaced fractures can be managed non-operatively with immobilization
- Displaced or unstable fractures require surgical intervention to restore anatomical alignment and preserve forearm function
- Post-operative care includes early range of motion exercises and weight-bearing restrictions
Treatment Options
- Immobilization in a long arm cast for non-displaced fractures
- Surgical fixation using plate and screw fixation or intramedullary nailing for displaced fractures
- Pain management with NSAIDs or acetaminophen
- Early range of motion exercises to prevent stiffness and promote healing
Complications and Monitoring
- Nonunion, malunion, and compartment syndrome are potential complications to monitor
- Restoring anatomical alignment is crucial to preserve forearm rotation and elbow/wrist function
- The ulna plays a critical role in forearm stability and rotational movement, making proper treatment essential to maintain quality of life and prevent long-term morbidity.
From the Research
Treatment Options for Ulnar Shaft Fractures
The treatment options for fractures of the ulna shaft include:
- Conservative management with immobilization using above-elbow or below-elbow plaster casts 2, 3
- Immediate mobilization without immobilization 4
- Surgical management with internal fixation using open reduction and plate fixation or closed intramedullary pinning 5, 6
Conservative Management
Conservative management involves immobilizing the fracture using a plaster cast. Studies have shown that:
- Above-elbow and below-elbow plaster casts can produce comparable results in terms of healing, time to healing, pain, and range of motion of the wrist 2
- Immobilization with a below-elbow plaster cast for 6 weeks can produce good results 2
- Immediate mobilization without immobilization can also produce good results with an average healing time of 6.7 weeks and no non-unions 4
Surgical Management
Surgical management involves internal fixation of the fracture using open reduction and plate fixation or closed intramedullary pinning. Studies have shown that:
- Surgical management can provide good results with a low rate of complications 5
- Open reduction and internal fixation can result in anatomical restoration of the ulna, but may not translate to better functional outcomes in the short term 6
- Intramedullary pinning can produce comparable results to open reduction and plate fixation, with minimal complications 5
Comparison of Treatment Options
Studies have compared the outcomes of different treatment options, including:
- A prospective, randomized study found no significant difference in time to union between long arm plaster immobilization, short arm plaster immobilization, and Ace Wrap bandage 3
- A study found no difference in functional outcomes and radiological union between open reduction and internal fixation and long arm cast 6