synonyms:Ulnar Shaft Fracture ORIF, ulna fracture ORIF
Ulnar Shaft Fracture ORIF CPT
Ulnar Shaft Fracture ORIF Indications
- Displaced Middle 1/3 (>50%displacement, >10° angulation)
- Proximal 1/3: ORIF, even non-displaced fractures have high propensity to displace with time.
- Displaced Distal 1/3: ORIF
Ulnar Shaft Fracture ORIF Contraindications
- Soft tissue compromise
Ulnar Shaft Fracture ORIF Alternatives
- Functional fracture brace, long arm casting
- External Fixation
Ulnar Shaft Fracture ORIF Pre-op Planning
- Ensure appropriate fixation is availble.
- Pre-countered plates are now available from various manufactures.
- Synthes 2.0mm LCP Distal Ulnar plate:
- Biomet / Hand innovations 2.5mm Distal Ulnar plate
Ulnar Shaft Fracture ORIF Technique
- Sign operative site.
- Pre-operative antibiotics, +/- regional block.
- Supine position. Hand table; tourniquet high on arm; all bony prominences well padded.
- General endotracheal anesthesia
- Prep and drape in standard sterile fashion. Arm exsagninated with Esmarch, tourniquet inflated
- Ulnar fixation via straight dorsal approach along subcutaneous border of ulna. Place plate dorsal surface of ulna beneath the ECU
- Minimize periosteal stripping and soft tissue dissection as much as possible
- Expose fracture, reduce and plate using standard AO technique. Generally 8-cortices above and below fracture. For purely transverse fractures 6-cortices (6 hole plate) is effective.
- Close in layers.
Ulnar Shaft Fracture ORIF Complications
Ulnar Shaft Fracture ORIF 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 ORIF Outcomes
- Generally heal well in 8-12 weeks
- Consider hardware removal at 12 months if plate is prominent and painful.
Ulnar Shaft Fracture ORIF Review References