Ulnar Shaft Fracture 813.22

synonyms: nightstick fracture, forearm fx, ulnar shaft fracture

Ulnar Shaft Fracture ICD-9

• 813.22(closed, ulna fracture alone)
• 813.32(open, ulna fracture alone)

Ulnar Shaft Fracture Etiology / Epidemiology / Natural History

• Most fractures of the ulnar shaft are caused by direct blows and result in minimal soft-tissue injury. 

Ulnar Shaft Fracture Anatomy

• see Muscles of the Forearm, Forearm Bone Anatomy
• Forearm Cross Sectional Anatomy

Ulnar Shaft Fracture Clinical Evaluation

• Generally obvious gross deformity
• Evaluate Soft Tissue Injury.
• Document NV exam. 
• Evaluate for Compartment Syndrome.

Ulnar Shaft Fracture Xray / Diagnositc Tests

• A/P and Lateral of radius/ulna to include elbow and wrist
• Separate views of wrist and elbow if indicated
• Template before case

Ulnar Shaft Fracture Classification / Treatment

• "Non-Displaced" Middle 1/3 (<50%displacement, <10° angulation): functional fracture brace or long arm cast. Ensure distal radioulnar joint is reduced.
• Displaced Middle 1/3 (>50%displacement, >10° angulation): ORIF
• Proximal 1/3: ORIF, even non-displaced fractures have high propensity to displace with time.
• Non-Displaced Distal 1/3 (<5%displacement, <2° angulation): displacement in the distal 1/3 is poorly tolerated. Functional fracture brace or long arm cast if truely nondisplaced. Ensure distal radioulnar joint is reduced.
• Displaced distal 1/3: ORIF
• ORIF: 8 cortices above and below recommended
• Nonsurgical treatment leads to a high rate of union and a good functional outcome. (Zych GA, CORR 1987;219:194). 
• AO Classification
• Open Fracture Classification

Ulnar Shaft Fracture Associated Injuries / Differential Diagnosis

• Monteggia Fracture.
• Radius and Ulnar Shaft Fracture.
• Galeazzi Fracture

Ulnar Shaft Fracture Complications

• Superficial wound infection
• contracture
• Nonunion: (incidence is higher for comminuted or displaced fx's)
• Hardware failure
• Malunion
• Painful Hardware
• Ulnar nerve palsy
• Radial nerve palsy

Ulnar Shaft Fracture Follow-up Care

• Post-op: Volar plaster splint with sling. NWB. Active elbow and finger ROM.
• 7-10 Days: Wound check, Place in funtional brace (interosseous mold). Begin active pronation/supination. Continue active elbow and finger ROM. Activity restrictions. Use for arm for light ADLS only. NWB.
• 6 Weeks: Gradually resume normal activites provided bony union is evident on xrays.
• 3 Months: Consider bone stimulator if union is not evident on xray.
• 6 Months: return to sports / full activities.
• 1Yr: Follow-up xrays, assess outcomes.

Ulnar Shaft Fracture Review References

• Rockwood and Green's Fractures in Adults: 2009
• Zych GA, Latta LL, Zagorski JB:  Treatment of isolated ulnar shaft fractures with prefabricated functional fracture braces.  Clin Orthop 1987;219:194-200.ICD-9