Treatment of Non-Displaced Intraarticular Proximal Ulna Fractures
For a non-displaced intraarticular fracture at the proximal ulna, immobilization with a removable splint or short-arm cast for approximately 3 weeks is the recommended treatment, with immediate initiation of active finger motion exercises to prevent stiffness. 1, 2
Initial Management Approach
Non-displaced intraarticular fractures can be managed conservatively since they lack significant displacement (>3mm) or angulation (>10°) that would necessitate surgical intervention 1, 2
A removable splint is the preferred immobilization method for minimally displaced fractures, as it allows for early mobilization while providing adequate stability 1, 2
Short-arm immobilization is equally effective as long-arm immobilization for ulnar fractures and offers better patient comfort and function 3
Critical Early Mobilization Protocol
Begin active finger motion exercises immediately upon diagnosis to prevent stiffness, which represents the most functionally disabling complication of upper extremity fractures 4, 2
Finger motion does not adversely affect adequately stabilized fractures in terms of reduction or healing 2
Early mobilization prevents the approximately 14.7% risk of immobilization-related complications including skin irritation and muscle atrophy 4, 1
Follow-Up and Monitoring
Obtain radiographic follow-up at approximately 3 weeks to confirm adequate healing and proper alignment 1, 2
Perform additional imaging at the time of immobilization removal to document union 1, 2
Monitor specifically for any loss of joint congruity, as intraarticular extension can lead to subsequent arthritis if joint alignment is not maintained 4
Red Flags Requiring Surgical Consideration
If displacement exceeds 3mm or angulation exceeds 10°, surgical fixation becomes necessary rather than conservative management 1, 2
Any loss of joint congruity on follow-up imaging warrants orthopedic consultation for possible operative intervention 4
Development of significant pain or functional limitation during the immobilization period may indicate inadequate fracture stability 3
Common Pitfalls to Avoid
Avoid prolonged immobilization beyond what is necessary for fracture stability, as this increases stiffness risk without improving outcomes 1
Do not use long-arm immobilization, as it provides no advantage over short-arm casting for ulnar fractures and unnecessarily restricts elbow motion 3
Never delay finger motion exercises, as joint stiffness develops rapidly and is difficult to reverse once established 4, 2