OWL: OCOSH Classification/Trauma/Fractures/Ulnar Fractures/Nightstick Fracture

Forearm Fractures - AO Surgery Reference

Michael Redies — 2006-06-05 00:20:34 GMT

The radius/ulna section of the AO Surgery Reference. The whole surgical management described, including decision-making support, approaches, and surgical procedures.

Forearm Fractures eMedicine Orthopedics

Kakarala & Simons — 2008-04-01 00:20:34 GMT

The forearm is a complex anatomic structure serving an integral role in upper extremity function. The dexterity of the upper limb is dependent on a combination of hand and wrist function and forearm rotation. The forearm bones can be considered struts linking 2 halves of a condylar joint formed by the proximal and distal radioulnar joints. Thus, any change in the geometry of the radius or ulna alters the congruency and range of motion of this condylar joint.
Synonyms and related keywords: fractures of the radius and ulna, ulna fracture, radius fracture, radial fracture, ulnar fracture, broken arm, broken ulna, broken radius, broken forearm, fracture of both bones of the forearm
Kakarala & Simons 2007

Isolated ulnar shaft fractures

Gebuhr et al — 2009-11-12 00:20:34 GMT

In a prospective study, we randomly allocated 39 patients with isolated fractures of the lower two-thirds of the ulnar shaft to treatment either by a prefabricated functional brace or a long-arm cast. Significantly better wrist function and a higher percentage of satisfied patients were found in the braced group. Thirteen patients returned to employment while still wearing the brace but only one was able to work in a cast.
Isolated ulnar shaft fractures. Comparison of treatment by a functional brace and long-arm cast. Gebuhr P, H�lmich P, Orsnes T, Soelberg M, Krasheninnikoff M, Kjersgaard AG. J Bone Joint Surg Br. 1992 Sep;74(5):757-9.Full text

Operative treatment for isolated distal ulnar shaft fracture

Kang et al — 2009-11-12 00:20:34 GMT

This study retrospectively evaluated the effectiveness of an open reduction and internal fixation of a tension band wiring technique for treating displaced or unstable comminuted distal ulnar shaft fractures without a radial fracture. Ten patients were treated for an isolated distal ulnar shaft fracture. There were 6 cases of a fracture 2.5 cm below the lower end of the ulna, and 4 cases with the fracture being 2.5 cm to 5 cm away from the lower end of the ulna. The authors classified the fractures of the distal ulnar into 3 types: a type I-simple fracture, a type II-comminuted fracture without a distal radioulnar joint (DRUJ) involvement, and a type III- comminuted fracture with DRUJ involvement. There were 3 cases of a type I fracture, 4 of type II and 3 of type III. The open reduction and internal fixation using tension band wiring were performed in 10 of these cases. After the operation, the wrist was placed in a cast for six weeks before active movement was allowed. The clinical results were excellent in 7 cases, good in 2 and poor in 1. In conclusion, tension band wiring surgery is recommended for treating an isolated distal ulnar with unreduced displaced fractures, in a comminuted fracture that cannot be maintained by a closed reduction and when there is the potential encroachment of fracture fragments in the DRUJ.
Yonsei Med J. 2002 Oct;43(5):631-6. Full text Operative treatment for isolated distal ulnar shaft fracture. Kang HJ, Shim DJ, Yong SW, Yang GH, Hahn SB, Kang ES.

The treatment of isolated fractures of the distal ulna

Dymond IW. — 2009-11-12 00:20:34 GMT

The integrity of the periosteum and the interosseous membrane determine the stability of fractures of the distal ulna; this is indicated by the initial displacement. In fractures displaced by less than 50% the periosteum and interosseous membranes are largely intact; these fractures are stable and require only below-elbow immobilisation for protection and relief of pain. In fractures displaced by more than 50% the membranes are disrupted; these fractures are unstable and require above-elbow immobilisation for stability. As most fractures are displaced by less than 50%, immobilisation of the elbow, which significantly increases morbidity, is usually unnecessary. I report the results of a cadaveric study on the pathomechanics of fractures of the distal ulna, and of a prospective clinical trial in which the type of cast used for immobilisation was determined by the stability of the fracture.
The treatment of isolated fractures of the distal ulna. Dymond IW. J Bone Joint Surg Br. 1984 May;66(3):408-10. Full text

Ulna shaft fracture - Orthopaedia

Not Available — 2009-11-12 00:20:34 GMT

Forearm fractures more commonly occur in men than women, owing to a higher incidence in men of participation in contact sports, altercations, falls from height, and motor vehicle collisions. Ulna shaft fractures may occur from direct trauma along its subcutaneous border, classically described as a "nightstick fracture" as a victim attempts to protect the head from assault.

Ulnar Shaft Fracture Wheeless

C.R.Wheeless — 2009-11-12 00:20:34 GMT

- night stick fracture: mechanism: direct trauma w/ forearm used to block blow
- stable frx:
- diplaced < 50% = Stable;
- periosteum & interosseous membrane are intact & act as restraint to rotation;
- unstable fracture:
- displaced > 50% or > 10-15 deg angulation;
- angulation or displacement towards the interosseous membrane is poorly tolerated;
- periosteum and interosseous membrane disrupted;
- associated injuries: radial head frx or dislocation