Ulnar bone fracture medical therapy: Difference between revisions
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==Non-surgical therapy== | ==Non-surgical therapy== | ||
* The first step in managing a patient with a fracture is to stabilize the patient if he/she is unstable due to blood loss, etc by giving them intravenous fluids and giving them some painkillers if the pain is severe | * The first step in managing a patient with a fracture is to stabilize the patient if he/she is unstable due to blood loss, etc by giving them intravenous fluids and giving them some painkillers if the pain is severe. | ||
* In children, the usual plan is to attempt closed reduction followed by cast immobilization. In adults, treatment with immobilization in a molded long arm cast can be used in those rare occasions of a non-displaced fracture of both bones of the forearm. If the fracture shifts in position, it may require surgery to put the bones back together<ref name=" | * In children, the usual plan is to attempt closed reduction followed by cast immobilization. In adults, treatment with immobilization in a molded long arm cast can be used in those rare occasions of a non-displaced fracture of both bones of the forearm. If the fracture shifts in position, it may require surgery to put the bones back together<ref name="pmid27454628">{{cite journal |vauthors=Kim JK, Kim JO, Koh YD |title=Management of Distal Ulnar Fracture Combined with Distal Radius Fracture |journal=J Hand Surg Asian Pac Vol |volume=21 |issue=2 |pages=155–60 |date=June 2016 |pmid=27454628 |doi=10.1142/S2424835516400075 |url=}}</ref>. | ||
* Rigid immobilization is suggested in preference to removable splints in nonoperative treatment for the management of ulnar bone fractures. | |||
* For all patients with ulnar bone fractures, a post-reduction true lateral [[Radiography|radiograph]] is suggested . | |||
* Operative fixation is suggested in preference to [[Orthopedic cast|cast]] fixation for fractures with post-reduction radial [[shortening]] greater than 3 mm, dorsal tilt greater than 10º, or intra-articular displacement or step-off greater than 2 mm. | |||
* Patients probably do not need to begin early wrist motion routinely after stable [[Bone fracture|fracture]] fixation. | |||
* Adjuvant treatment of ulnar bone fractures with vitamin C is suggested for the prevention of disproportionate [[pain]]. | |||
* | |||
== Complications of Non-surgical therapy == | |||
Failure of non-surgical therapy is common<ref name="pmid28988738">{{cite journal |vauthors=Alfaraj DN, Vilke GM |title=Tripartite Fracture of the Ulnar Sesamoid Bone of the Thumb |journal=J Emerg Med |volume=53 |issue=5 |pages=758–759 |date=November 2017 |pmid=28988738 |doi=10.1016/j.jemermed.2017.08.020 |url=}}</ref>: | |||
* Re-displacement to its original position even in a cast | |||
* [[Stiffness]] | |||
* Post traumatic [[osteoarthritis]] leading to wrist pain and loss of function | |||
* Other risks specific to cast treatment include: | |||
** Compression of the swollen arm causing [[compartment syndrome]] or [[carpal tunnel syndrome]] | |||
** [[Reflex sympathetic dystrophy]] is a serious complication | |||
** Stiffness is universal following a prolonged period of immobilization and swelling | |||
==References== | ==References== | ||
<references /> | <references /> | ||
Latest revision as of 00:32, 17 January 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2] ;
Overview
The first step in managing a patient with a fracture is to stabilize the patient if he/she is unstable due to blood loss, etc by giving them intravenous fluids and giving them some painkillers if the pain is severe. If only one bone is broken, using cast or brace might be a possible treatment option.
Non-surgical therapy
- The first step in managing a patient with a fracture is to stabilize the patient if he/she is unstable due to blood loss, etc by giving them intravenous fluids and giving them some painkillers if the pain is severe.
- In children, the usual plan is to attempt closed reduction followed by cast immobilization. In adults, treatment with immobilization in a molded long arm cast can be used in those rare occasions of a non-displaced fracture of both bones of the forearm. If the fracture shifts in position, it may require surgery to put the bones back together[1].
- Rigid immobilization is suggested in preference to removable splints in nonoperative treatment for the management of ulnar bone fractures.
- For all patients with ulnar bone fractures, a post-reduction true lateral radiograph is suggested .
- Operative fixation is suggested in preference to cast fixation for fractures with post-reduction radial shortening greater than 3 mm, dorsal tilt greater than 10º, or intra-articular displacement or step-off greater than 2 mm.
- Patients probably do not need to begin early wrist motion routinely after stable fracture fixation.
- Adjuvant treatment of ulnar bone fractures with vitamin C is suggested for the prevention of disproportionate pain.
Complications of Non-surgical therapy
Failure of non-surgical therapy is common[2]:
- Re-displacement to its original position even in a cast
- Stiffness
- Post traumatic osteoarthritis leading to wrist pain and loss of function
- Other risks specific to cast treatment include:
- Compression of the swollen arm causing compartment syndrome or carpal tunnel syndrome
- Reflex sympathetic dystrophy is a serious complication
- Stiffness is universal following a prolonged period of immobilization and swelling
References
- ↑ Kim JK, Kim JO, Koh YD (June 2016). "Management of Distal Ulnar Fracture Combined with Distal Radius Fracture". J Hand Surg Asian Pac Vol. 21 (2): 155–60. doi:10.1142/S2424835516400075. PMID 27454628.
- ↑ Alfaraj DN, Vilke GM (November 2017). "Tripartite Fracture of the Ulnar Sesamoid Bone of the Thumb". J Emerg Med. 53 (5): 758–759. doi:10.1016/j.jemermed.2017.08.020. PMID 28988738.