Ulnar Neck Fractures Associated with Distal Radius Fractures

Distal ulnar neck fracture displacement with forearm rotation: A biomechanical cadaveric study

Management of distal ulnar fractures remains controversial, partly due to its low incidence and operative challenges encountered during surgical fixation. This cadaveric study examined fracture displacement in isolated distal ulnar fractures, specifically AO Muller Q2 and Biyani Type I fracture pattern, during forearm pronosupination.6 fresh frozen cadaveric upper limbs amputated at mid-humerus were used. Soft tissues including proximal and distal radioulnar joints were carefully preserved. Specimens were inspected grossly and radiographically for absence of pathologies. Radiocarpal and midcarpal pinning was performed to facilitate quantification of forearm rotation. 2 markers were each placed proximal and distal to fracture site to quantify fracture displacement. 3-dimensional positional data was recorded using an optoelectronic system (Vicon MX motion capture system).Distance between the 2 markers increased in the proximodistal and radioulnar axis, and decreased in the dorsovolar axis when the forearm was rotated from neutral to 100° pronation. The inverse was observed during supination. Mean aggregate fracture site displacement increased to 9.17 ± 2.78 mm at 100° pronation. Statistically significant increase in aggregate fracture site displacement was observed from 60° pronation onwards. At 100° supination, the aggregate fracture site displacement was 4.58 ± 8.62 mm. When supinating from neutral to 100°, fracture displacement did not increase significantly.

Results

from this study suggest that distal ulnar fractures are potentially stable, particularly in supination. However, unrestricted forearm pronation with inadequate immobilisation might still cause further fracture displacement. Further studies are required to assess distal ulnar fracture stability in vivo before treatment guidelines can be established.

Elastic stable intramedullary nails compared to locking compression plates for treating unstable distal ulnar fractures in adults: a prospective comparative study

BACKGROUND AND PURPOSE

Distal ulna fractures often occur in conjunction with distal radius fractures and other associated injuries. Currently, there are no satisfactory internal fixation systems available for addressing unstable distal ulna fractures, and a definitive consensus on the most effective treatment approach is still lacking. The objective of this research was to evaluate the clinical outcomes of using elastic stable intramedullary nails (ESIN) compared to locking compression plates (LCP) for treating unstable distal ulnar fractures in adults.

METHODS

In a prospective clinical study, a total of 54 patients (21 females and 33 males; average age 49.3 years, ranging from 30 to 63 years) suffering from unstable or displaced fractures of the distal ulna were randomly allocated to one of two treatment groups between January 2021 and August 2024. Specifically, 26 patients underwent treatment utilizing elastic stable intramedullary nails, whereas 28 patients were managed using locking compression plates. The two groups were evaluated prospectively for perioperative data and functional results.

RESULTS

The ESIN group comprised 26 patients, exhibiting a mean age of 48.27 years (with a range of 30 to 62 years), while the LCP group included 28 patients, whose mean age was 50.33 years (ranging from 32 to 63 years). Both groups were comparable regarding gender distribution, side of injury, mechanisms of injury, and classifications of fractures. However, there were significant differences noted in incision length of the ulna, surgical duration, frequency of fluoroscopy, and the rates of excellent and good functional outcomes as measured by the Gartland-Werley scores between the two groups (P < 0.05). Conversely, no significant differences were found concerning the time to union and the duration of immobilization between the two groups (P > 0.05).

CONCLUSION

ESIN offers several advantages, including reduced incision length, lower frequency of fluoroscopy, shorter duration of the surgical procedure, decreased complication rates, and improved Gartland-Werly scores. Therefore, fixation using ESIN serves as an effective alternative for the treatment of distal ulnar fractures in adults. The minimally invasive nature and lower complication rates are defining characteristics of ESIN fixation.

Surgical fixation of distal ulna neck and head fractures

OBJECTIVES

Distal ulna plate fixation for ulnar neck and head fractures (excluding ulnar styloid fractures) aims to anatomically reduce the distal ulna fracture (DUF) by open reduction and internal fixation, while obtaining a stable construct allowing functional rehabilitation without need for cast immobilization.

INDICATIONS

Severe displacement, angulation or translation, as well as unstable or intra-articular fractures. Furthermore, multiple trauma or young patients in need of quick functional rehabilitation.

CONTRAINDICATIONS

Inability to surgically address concomitant ipsilateral extremity fractures, thus, limiting early active rehabilitation. Stable, nondisplaced fractures. Need for bridging plate or external fixator of distal radiocarpal joint.

SURGICAL TECHNIQUE

An ulnar approach, with a straight incision between the extensor and flexor carpi ulnaris. Preservation of the dorsal branch of the ulnar nerve. Reduction and plate fixation with avoidance of plate impingement in the articular zone.

POSTOPERATIVE MANAGEMENT

Postoperatively, an elastic bandage is applied for the first 24-48 h. In isolated DUF with stable fixation, a postoperative splint is often unnecessary and should be avoided. For the first four weeks, only light weightbearing of everyday activities is allowed to protect the osteosynthesis. Thereafter, heavier weightbearing and activities are allowed and can be increased as tolerated.

RESULTS

The best available evidence likely shows that for younger patients with a DUF, with or without concomitant distal radius fractures, open reduction and internal fixation can be safely achieved with good functional outcome and acceptable union and complication rates as long as proper technique is ensured.

Distal ulna fractures in adults-subcapitular, transverse fractures did not benefit from surgical treatment

INTRODUCTION

Fractures of the distal ulna, excluding the styloid, are rare. The cause of injury is often a fall on an outstretched hand with an extended wrist, and in most cases there is a concomitant distal radius fracture. The aims of this retrospective study were to investigate the results of the current treatment of distal ulna fractures in adults, with or without a concomitant distal radius fracture, and if a recently presented fracture classification could predict outcome.

MATERIALS AND METHODS

Patients, 18 years or older, treated for a fracture of the distal third of ulna in our county, were included. Fractures of the styloid tip were excluded. The radiographs of the fractures were independently classified by two specialists in radiology according to the 2018 AO/OTA classification. Follow-up was performed 5-7 years after the injury, through the questionnaire Patient-Rated Wrist Evaluation (PRWE) and new radiographs of both wrists.

RESULTS

Ninety-six patients with 97 fractures were included and filled out the PRWE. 65 patients also had new radiographs taken. 79 patients were women and the mean age at the time of injury was 63 years (SD 14.5). The most common fracture class was the extra-articular transverse fracture, 2U3A2.3 (42%). We found that 40% of the fractures had been treated by internal fixation and only 2 fractures had not healed, one conservatively treated and one operated. The median PRWE was 15 (IQR 33.5). The PRWE score was significantly worse in the operated ulna fractures (p = 0.01) and this was also true for extra-articular transverse fractures 2U3A2.3 (p = 0.001). Initial displacement was more common in operated transverse fractures, but it could not be proven that this was the reason for the inferior result.

CONCLUSIONS

Distal ulna fractures almost always unite and the result is comparable to that of isolated distal radius fractures when measured by PRWE. Based on the opinions of the radiologists and how often a consensus discussion was needed for classification, we found the updated AO classification system difficult to use, if dependent only on standard radiographic views. In the present study, transverse extra-articular ulna fractures did not benefit from internal fixation regardless if associated with a distal radius fracture or isolated.

The Effect of Ulnar Styloid Fractures on Patient-Reported Outcomes After Surgically Treated Distal Radial Fractures

Ulnar styloid fractures (USFs) are often associated with distal radial fractures (DRFs). When unstable DRFs are treated surgically, any associated USF is most commonly left untreated. The purpose of this study was to evaluate the effect of a concomitant USF on outcome after surgical stabilization of a DRF.

Does Simultaneous Fixation of Both Distal Radius and Distal Ulnar Fractures Improve Outcomes? A Retrospective Cohort Study

Introduction: Distal metaphyseal ulnar fractures are often found in conjunction with distal radius fractures. However, there is no consensus on optimal management. The purpose of this study was to determine whether simultaneous fixation of both distal radius and distal ulnar fractures would improve outcomes. Materials and Methods: Patients treated for distal radial fractures over a 4-year period at our trauma center were identified, and their medical records were analyzed. Twenty-three patients met the inclusion criteria for this study. All radius fractures were fixed using a volar locking plate. Fourteen ulnar fractures were treated with surgical fixation, and nine were treated conservatively. Data were collected on patient demographics, mechanism of injury, whether it was a closed or open fracture, Gustilo classification, AO/OTA classification, immobilization period, follow-up period, and type of treatment. Physical findings comprising the active range of motion and grip strength and radiological findings, including the ulnar variance compared to the healthy side and bone union, were evaluated. Clinical outcomes were assessed using the quick Disabilities of the Arm, Shoulder, and Hand scores. Results: There was no significant difference between the groups in the quick Disabilities of the Arm, Shoulder, and Hand scores, but the arc of dorsi-palmar flexion was more restricted in the operative group than in the conservative group. Other results were not significantly different between the two groups. Discussion: Fixation of distal metaphyseal ulnar fractures can be challenging, and several studies have shown the validity of conservative treatments. This supports the view that if the distal radius fracture is anatomically and rigidly fixed, distal metaphyseal ulnar fractures can be successfully managed conservatively. Conclusion: Our results did not show any merit in the simultaneous fixation of both distal radius and distal ulnar fractures. Thus, needless surgery should be avoided.