Ulnar bone fracture interventions

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

Overview

Returning to the normal physical activity after ulnar fracture can take weeks to months of therapy under supervision an orthopedist. Meanwhile, a physiotherapy can be helpful for patient to achieve the normal wrist and elbow function caused by the immobilisation.

Operation

• There are a variety of methods and implants useful to stabilize the ulnar bone fractures, ranging from closed reduction and percutaneous pin fixation to the use of intra-medullary devices.
• However, the most common fixation methods to treat complex ulnar bone fractures include external fixation, and open reduction and internal fixation.

External Fixation With or Without Percutaneous Pin Fixation

• Wrist spanning external fixation employs ligamentotaxis to restore and maintain length, alignment, and rotation of ulnar bone.
• Reduction is typically obtained through closed or minimally open methods and preserves the fracture biology.
• The addition of percutaneous pins enhances the ability to reduce and stabilize fracture fragments.

Complications of External Fixation

• Pin tract infection
• Injury to the superficial branch of the nerve
• Complex regional pain syndrome

Open reduction and internal fixation with plates and screws

• This is the most common type of surgical repair for ulnar bone fractures.
• During this type of procedure, the bone fragments are first repositioned (reduced) into their normal alignment.
• The bones held together with special screws and metal plates attached to the outer surface of the bone.

Complications of open reduction and internal fixation with plates and screws

• Infection
• Damage to nerves and blood vessels
• Synostosis
• Nonunion

Pain Management

Pain after an injury or surgery is a natural part of the healing process.

Medications are often prescribed for short-term pain relief after surgery or an injurysuch as:

• opioids
• non-steroidal anti-inflammatory drugs (NSAIDs)
• local anesthetics

Interventions

The following options can be helpful for patients to rehabilitate after their fracture :

• Joints mobilization
• compression bandage
• Soft tissue massage
• Exercises and Activity modification
• Forearm taping
• Forearm bracing

Postoperative Rehabilitation

• Complex Ulnar bone fracture warrant individualized immobilization and rehabilitation strategies.
• Similarly, the addition of a thumb spica cast or orthosis with positioning of the wrist in slight ulnar deviation for management of a comminuted radial column fracture may prevent loss of reduction. *Because most multifragmentary ulnar bone fractures are the result of high-energy injuries, a prolonged period of wrist immobilization and soft-tissue rest may be beneficial and has not been shown to affect clinical outcomes.
• The wrist is typically immobilized for 2 weeks post-operatively in a sugar tong splint with neutral forearm rotation.
• At 6 weeks post-operatively, the wrist is placed into a removable orthosis, and active and passive range of motion (ROM) is initiated.
• Full weight bearing commences at approximately 3 months post-operatively after consolidation of the fracture is noted on radiographs.
• The presence of varying degrees of hand, wrist, and elbow stiffness is inevitable and may result from poor pain control, lack of effort in controlled mobilization, edema, concomitant ipsilateral upper extremity fractures, or peripheral nerve injuries.
• Early stretching and mobilization of the intrinsic and extrinsic tendons of the hand is important to prevent finger stiffness.
• Edema control can be initiated with compression gloves, digital massage, and active and passive ROM of the hand.
• A home exercise program or outpatient occupational therapy is started immediately post-operatively to maintain full range of motion of the hand and limit the development of intrinsic muscle tightness