Management of Linear, Nondisplaced Fracture of Ulna Near Elbow Joint
For a linear, nondisplaced ulnar fracture near the elbow joint, immobilize with a posterior splint for 2-3 weeks followed by early mobilization, with radiographic follow-up to confirm healing and rule out late displacement. 1
Initial Immobilization Strategy
- Apply a posterior splint for initial stabilization, as this provides superior pain relief compared to other immobilization techniques and adequate stabilization for nondisplaced fractures near the elbow 1
- The duration of rigid immobilization should be limited to 2-3 weeks maximum to prevent stiffness, which is one of the most functionally disabling complications 2
- Nondisplaced fractures of the ulna are inherently stable when displacement is minimal, requiring only short-term protection rather than prolonged casting 3
Early Mobilization Protocol
- Begin active finger motion exercises immediately after splint application to prevent stiffness 2
- After 2-3 weeks of immobilization, transition to mobilization as tolerated - this approach has demonstrated superior outcomes with average healing time of 6.7 weeks compared to 10.5 weeks with prolonged immobilization 4
- Early mobilization in stable ulnar fractures results in zero non-union rates compared to 8% with prolonged casting 4
- Forearm rotation exercises should be incorporated once pain allows, as average loss of rotation is only 5 degrees with early mobilization 4
Radiographic Monitoring
- Obtain radiographic follow-up at approximately 3 weeks to confirm adequate healing and detect any late displacement 1, 2
- Regular radiographic surveillance is essential because nondisplaced fractures can occasionally displace secondarily 1
- Repeat imaging at the time of immobilization removal to document union 2
Key Clinical Pitfalls to Avoid
- Do not immobilize the elbow joint unnecessarily - below-elbow immobilization is sufficient for stable, minimally displaced ulnar fractures 3
- Avoid prolonged rigid immobilization beyond 3 weeks, as this significantly increases morbidity through joint stiffness without improving healing outcomes 4
- Assess for associated injuries, particularly elbow instability or coronoid involvement, as these would require different management 5
- Monitor for skin irritation or muscle atrophy, which occurs in approximately 14.7% of immobilization cases 2
When Conservative Management is Appropriate
- Fractures with less than 50% displacement indicate intact periosteum and interosseous membrane, making them stable and suitable for conservative treatment 3
- Linear, nondisplaced fractures by definition meet this criterion and can be managed non-operatively 6
- The absence of angulation, displacement, or associated elbow instability confirms appropriateness of splinting alone 7