1 Preliminary remark topenlarge
Comminuted fractures of the distal ulna usually occur in combination with distal radial fractures.
In multifragmentary ulnar fractures, there is instability and shortening, and bridge plating is the chosen means of stable internal fixation.
Attention should be paid to restoring correct rotation and correct length in relation to the radius.
Complete dislocation of the radiocarpal joint is often associated with disruption of the distal radioulnar joint (DRUJ).
2 Patient preparation and approach topenlarge
This procedure is normally performed with the patient in a supine position for distal ulnar fractures.
For this procedure an ulnar approach is normally used.
3 Reduction and plate fixation topenlarge
Insertion of the plate
Choose a plate which will be of sufficient length to obtain adequate fixation in the proximal and distal fragments after the fracture has been reduced.
If available, a low profile plate should be used, as soft tissue irritation is a common postoperative problem.
The plate is inserted using one screw distally, then alignment of the distal fragment with the proximal shaft is achieved, before the second screw is inserted.
If the distal fragment is small, fixation may be more secure if a condylar or a T-plate is used.
Reduction with plate and hook
Reduction is then achieved by manipulation of the distal fragment, using the plate, possibly with the help of a hook, to restore anatomical length and rotation in relation to the distal radius.
Insertion of proximal screws
Check this reduction, using intraoperative image intensification, before proximal fixation of the plate.
The fracture zone is bridged, with no attempt to reduce the individual fragments of the multifragmentary zone, and the plate then secured to the proximal shaft using screws inserted in a neutral fashion.
An x-ray image of the uninjured side allows comparison of the configuration of the DRUJs.