Ulnar fracture

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2] ;

The forearm comprises of 2 long bones: radius and the ulna; they forms joints with the humerus. The ulnar fracture is known as the break in the ulna bone during any trauma affecting this side of body. An ulna as one of the long bones of the forearm is located in in human upper limb and its fracture is a relatively common condition. Forearm bones can break in different ways: they can break into many pieces or can crack just slightly. These broken pieces my line up straight or be in a different location.

• Nightstick fracture: fracture of the middle portion of the ulna without other fractures.
• Hume fracture: fracture of the olecranon with an associated anterior dislocation of the radial head
• Distal ulna fractures: fracture occur along with distal radius fractures.
• Monteggia fracture: fracture of the proximal third of the ulna with the dislocation of the head of the radius

According to data from the 2010 National Electronic Injury Surveillance System (NEISS) database and the 2010 US Census, the forearm fractures accounted for 17.8% of all fractures and were the most common type of fracture in the pediatric population (With the range of 0-19 years). National Hospital Ambulatory Medical Care Survey showed that fractures of the radius, the ulna, or both accounted for 44% of all forearm and hand fractures in the United States. The fracture of ulna usually occurs in combination with other injuries such as a sprained or dislocated wrist or elbow, a fractured radius, or other fractures of the hand, wrist or forearm. Based on the affected area during the trauma the severity and type of injuries varies from avulsion fracture, stress fracture, medial epicondyle fracture, olecranon fracture, displaced fracture, un-displaced fracture to the greenstick, comminuted.

• Direct blow
• road / traffic accidents
• contact sports
• Falling

• Pain
• Swelling
• Bruising
• Inability to rotate arm
• Numbness in the fingers or wrist
• weakness in the fingers or wrist

• Physical Exam Main step
• X-ray is required to confirm diagnosis
• MRI, CT scan or bone scan for further investigations

• Nonsurgical Treatment
  • Cast
  • Brace

• Surgical Treatment
  • Open reduction and internal fixation with plates and screws.
  • Open reduction and internal fixation with rods
  • External fixation

Using appropriate management such as surgical or conservative treatments for the fractured ulna usually make a full recovery. One of the most important components for recovery is that the patient rests sufficiently. Evaluation of the fracture with follow up X-rays is important to ensure the fracture is healing in an ideal position. Getting back to activity or sport can be found in weeks to months but in patients with severe injuries involving other bones, soft tissue, nerves or blood vessels, recovery time may be somehow prolonged; meanwhile it should be guided by the orthopedic surgeon and treating physiotherapist.

Physiotherapy involving ulna bone:

• Soft tissue massage
• Joint mobilization
• Electrotherapy (e.g. ultrasound)
• Taping or bracing
• Exercises to improve strength and flexibility
• Activity modification

Based on the orthopedic surgeons opinion many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics.

The American Orthopaedic Association

American Academy of Orthopedic Surgeons

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2] ;

Classification of fractures is an important factor in patients management. Meanwhile the classification of ulnar fracture is important factor in orthopedic medicine.

• Descriptive^{[1][2][3][4][5][6]}
  • closed versus open
  • location
  • comminuted, segmental, multifragmented
  • displacement
  • angulation
  • rotational alignment
• OTA classification
  • radial and ulna diaphyseal fractures
    • Type A
      • simple fracture of ulna (A1), radius (A2), or both bones (A3)
    • Type B
      • wedge fracture of ulna (B1), radius (B2), or both bones (B3)
    • Type C
      • complex fractures

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2] ;

Ulnar Fracture usually classified according to the level of fracture, the pattern of the fracture, the degree of displacement, the presence or absence of comminution or segment bone loss, and whether it is open or closed. Each of these factors may have some bearing on the type of treatment to be selected and the ultimate prognosis.

The ulnar fracture is caused by a fall on the outstretched hands with the wrist in dorsiflexion position. The form and severity of this fracture depends on the position of the wrist at the moment of hitting the ground. The width of this mentioned angle affects the localization of the fracture. Pronation, supination and abduction positions leads the direction of the force and the compression of carpus and different appearances of injury^{[1][2][3][4][5][6][7][8]}.

• Open fracture: The ulnar bone breaks and pierces the skin also the ligament, muscle, and tendon damage, may be affected.
• Closed fracture: The ulnar bone do not cut the skin. However, injury to the soft tissues around the joint may occur.
• Comminuted fracture: In a comminuted ulnar fracture, the ulnar bone is broken into three or more pieces.
• Displaced fracture: The ulnar bone may fragment at the point of breakage and gets misaligned.
• Greenstick fracture: A greenstick ulnar fracture means that the ulnar bone is cracked, but not broken all the way through.
• Metaphyseal fracture: With this type, the ulnar fracture is confined to the upper/lower part of the shaft, but does not affect the growth plate.
• Buckle (or torus) fracture: A buckle ulnar fracture, also known as a torus ulnar fracture, occurs when one side of the ulnar bone is compressed or buckled, without fracturing the other side.
• Monteggia fracture: A fracture fracture type that affects both sides of the forearm.
• Galeazzi fracture: The ulnar fracture extends through an area of the bone, causing the bone to bend on the other side.

The Pathophysiologis of the Ulnar Fracture injury are^{[9][10][11][12][13]}=:

• Direct trauma to the arm/forearm
• Taking part in any rough or high-impact sport
• Street fights, gunshot wounds, and domestic violence, may also cause a Fracture of the Ulnar Bone
• Falling on an outstretched hand with the forearm pronated.
• Road traffic accidents.
• Athletic injuries.
• Gunshot wounds.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2].

There are different causes responsible for the ulnar fracture and each of the below mentioned causes may cause different type of fracture.

The causes for the ulnar bone fracture are^[1][2][3]:

• High-risk contact sports
• Higher age (elderly adults are higher prone to such fractures)
• Reduced bone density (osteoporosis)
• Direct blow
• Road / traffic accidents
• Falling

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2] ;

The prognosis ulnar fracture depends on many factors. However, the factors under the orthopedics surgeons control are: treatment method, timing of internal fixation in open fractures, soft-tissue handling, and restoration of osseous anatomy.

The type and frequency of complications of the ulnar fracture varies. Its been reported that the ulnar fracture related complication and post-traumatic arthritis rates are 6% – 80% and 7% -65%, respectively. Malunion with an intra-articular or extra-articular deformity non-union, tendon attrition/rupture complications and neurological injuries are the most frequent complication in this regard^[1][2][3].

The prognosis of ulnar fracture is more guarded for open fractures of the shaft of the ulna with major skin and soft-tissue loss. In these patients, several operative procedures may be necessary, including initial debridement and stabilization, skin grafting, pedicle or free-flap applications, late reconstruction of the bones, and, frequently, tendon transfers^[1][4][5].