Executive Editor: Steve Krikler

Authors: Renato Fricker, Jesse Jupiter, Matej Kastelec

Distal forearm Extraarticular simple fracture of the ulna

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Glossary

General considerations

These are simple fractures of the ulnar metaphysis, involving neither the ulnocarpal nor distal radioulnar joints.
If the ulna heals with shortening, it may cause later problems with the wrist joint.

Nonoperative treatment - Cast
Main indication Skill Equipment
Stable, undisplaced: reducible, transverse fracture Basic surgical experience, no specialized skills Basic equipment only

Indications

  • Stable fracture
  • Undisplaced
  • Simple (noncomminuted)
  • Stable DRU joint
  • Low-demand patient

Contraindication

  • Unstable distal radioulnar joint

Disadvantage

  • Increased risk of long-term mobility loss
ORIF - Lag screw and protection plate
Main indication Skill Equipment
Unstable fracture Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Oblique or spiral fracture
  • Locking plate preferable for short distal fragments
  • Displaced fracture
  • Irreducible fracture
  • Unstable fracture
  • Comminuted fracture (relative indication)

Contraindications

  • Poor condition of overlying soft-tissue envelope
  • Patient not fit for surgery

Advantages

  • Early mobilization
  • Healing in anatomical position

Disadvantages

  • Subcutaneous plate may cause irritation
  • Screws may cut out, particularly in osteoporotic bone
ORIF - Compression plate
Main indication Skill Equipment
Transverse, or short oblique fracture Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Transverse or short oblique fracture
  • Locking plate preferable for short distal fragments
  • Displaced fracture
  • Irreducible fracture
  • Unstable fracture
  • Comminuted fracture (relative indication)
  • Unstable DRU joint

Contraindications

  • Poor condition of overlying soft-tissue envelope
  • Patient not fit for surgery

Advantages

  • Early mobilization
  • Healing in anatomical position

Disadvantages

  • Subcutaneous plate may cause irritation
  • Screws may cut out, particularly in osteoporotic bone
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources