Ulnar fracture

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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 forearm comprises of 2 long bones: radius and the ulna; they forms joints with the humerus. The ulna fracture is known as the break in the ulna bone during any trauma affecting this side of body. An ulna as one of the long bones of the forearm is located in in human upper limb and its fracture is a relatively common condition. Forearm bones can break in different ways: they can break into many pieces or can crack just slightly. These broken pieces my line up straight or be in a different location.

Epidemiology and demographics

This fracture is common among the elderly people but it can be found among the younger patient. The fracture of ulna usually occurs in combination with other injuries such as a sprained or dislocated wrist or elbow, a fractured radius, or other fractures of the hand, wrist or forearm. Based on the affected area during the trauma the severity and type of injuries varies from avulsion fracture, stress fracture, medial epicondyle fracture, olecranon fracture, displaced fracture, un-displaced fracture to the greenstick, comminuted.

Cause

• Direct blow
• road / traffic accidents
• contact sports
• Falling

Sign and Symptoms

• Pain
• Swelling
• Bruising
• Inability to rotate arm
• Numbness in the fingers or wrist
• weakness in the fingers or wrist

Daignosis

• Physical Exam Main step
• X-ray is required to confirm diagnosis
• MRI, CT scan or bone scan for further investigations

Treatment

anatomical reduction (i.e. re-alignment of the fracture by careful manipulation under anesthetic)

surgical internal fixation

Prognosis

Evaluation of the fracture with follow up X-rays is important to ensure the fracture is healing in an ideal position. Once healing is confirmed and the plaster cast has been removed, rehabilitation can begin as guided by the treating physiotherapist.

One of the most important components of rehabilitation following an ulna fracture is that the patient rests sufficiently from any activity that increases their pain. Activities which place large amounts of stress through the ulna should also be avoided particularly lifting, weight bearing or pushing activities. Rest from aggravating activities allows the healing process to take place in the absence of further damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms. This should take place over a period of weeks to months with direction from the treating physiotherapist.

Ignoring symptoms or adopting a ‘no pain, no gain’ attitude is likely to cause further damage and may slow healing or prevent healing of the ulna fracture altogether.

Patients with a fractured ulna should perform pain-free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. This is particularly important, as soft tissue flexibility and strength are quickly lost with plaster cast immobilization. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they should be commenced.