Executive Editor: Peter Trafton, Michael Baumgaertner

Authors: Peter Kloen, David Ring

Proximal forearm Ulna, extraarticular, simple

back to skeleton

Glossary

Proximal ulna metaphyseal fractures are usually part of a more complex injury with subluxation or dislocation of the proximal radioulnar joint.

Nonoperative
Indication summary Skill Equipment
Minimally displaced, stable fracture Basic surgical experience, no specialized skills Basic equipment only

Further indications

  • Infirm and inactive patient

Contraindications

  • Polytrauma

Advantages

  • Avoid medical and surgical risks

Disadvantages

  • Displacement or nonunion can be problematic
Temporary external fixation
Indication summary Skill Equipment
Significant soft-tissue injury or contamination Some specialized surgical experience Simple surgical and imaging resources

Further indications

  • Infection
  • Polytraumatized patients (damage control)
  • Instability that cannot be controlled with splint or cast

Advantages

  • Quick procedure
  • Easy to perform
  • No additional damage to already injured tissue
  • Stabilizes the fracture for soft-tissue healing

Disadvantages

  • Temporary procedure
  • Pin-track complications
  • Iatrogenic nerve injury
Compression plate
Indication summary Skill Equipment
Displaced transverse fracture Some specialized surgical experience Simple surgical and imaging resources

Contraindications

  • Infirm patient (high anesthetic risk)
  • Infected or abraded skin. Let the skin heal first
  • Functionally low demand patient

Advantages

  • Anatomical reduction
  • Stable fixation
  • Early motion and function

Disadvantages

  • Prominent implant
  • Risks of infection, loosening of fixation, medical problems associated with anesthesia
Compression plate and lag screw
Indication summary Skill Equipment
Oblique fracture suitable for compression with both lag screw and plate Some specialized surgical experience Simple surgical and imaging resources

Contraindications

  • Infirm patient (high anesthetic risk)
  • Infected or abraded skin (let the skin heal first)
  • Functionally low demand patient

Advantages

  • Anatomical reduction
  • Stable fixation
  • Early motion and function

Disadvantages

  • Prominent implant
  • Risks of infection, loosening of fixation, medical problems associated with anesthesia
Lag screw and protection plate
Indication summary Skill Equipment
Oblique fracture. Interfragmentary compression by lag screw, but not plate. Some specialized surgical experience Simple surgical and imaging resources

Contraindications

  • Infirm patient (high anesthetic risk)
  • Infected or abraded skin. Let the skin heal first
  • Functionally low demand patient

Advantages

  • Anatomical reduction
  • Stable fixation
  • Early motion and function

Disadvantages

  • Prominent implant
  • Risks of infection, loosening of fixation, medical problems associated with anesthesia
*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

v2.0 2018-04-30