Treatment

What treatments should I consider?

Nonsurgical Treatment

An isolated fracture of the ulna, also called a nightstick fracture, may be treated in a cast. It is not as important to make the bone absolutely straight so the result of non-operative treatment is often acceptable. The arm is placed in a cast extending from the palm of the hand to above the elbow. This is called a long arm cast. The wrist is held in the neutral position and the elbow at 90 degrees of flexion. It may be painful to put on this cast so an anesthetic may be required for cast application.

Surgery

If the ulna shaft fracture is badly displaced the treatment may be surgery to replace the bone fragments in the correct position and fixation to hold them in place. This has the additional advantage of allowing early movement of the limb.

For reasons described earlier, a fracture of both forearm bones needs to heal with great accuracy. Closed reduction, in which the bone ends are re-aligned without surgery is often not accurate enough. However, in some circumstances a closed reduction is tried. If this is successful the arm will be immobilized in a long arm cast. There is a risk that the fracture will displace in the cast, so frequent follow-up X-rays will be needed.

In the majority of cases, the surgeon will recommend surgery to ensure that the fracture is reduced accurately and fixed with internal fixation. Fixation with plates and screws is a common method although some surgeons recommend the less invasive method of placing a rod into the hollow medullary cavity of the bone, called intramedullary fixation.

Because fixation allows early recovery of movement of the forearm and hand, the long term risk of stiffness and loss of function is reduced. After surgery (internal fixation) a cast is not usually necessary although the limb should not be loaded until the bone is healed. A sling for protection and pain relief is usual practice but unloaded hand, wrist, and elbow movements can be started right away.

Removal of the implants is controversial. The hardware is often uncomfortable and in those cases the patient and surgeon usually agree to removal. However, about 1/10th of these cases have a re-fracture within six weeks of the removal operation. This risk deters some surgeons from removal of the hardware where there are no symptoms. Others believe that the life-time risk of a problem from a retained plate is great enough to warrant removal of plates as a precaution.