Distal Ulna Fracture · What Is It, Management, and More

A distal ulna fracture, or isolated ulnar shaft fracture, is a type of fracture that occurs along the length of the ulna bone, which is one of the two bones in the forearm. A distal ulna fracture may occur at different sections of the ulna bone, such as near the wrist at the farthest (distal) end of the bone, the middle of the ulna bone, or near the elbow at the top (proximal) end of the ulna bone.

A distal ulna fracture is typically diagnosed by a medical professional after physical examination and imaging of the forearm. A physical examination of the forearm in an individual with a distal ulna fracture may reveal deformity of the forearm, discoloured skin, open wounds, and tense forearm compartments. A neurovascular examination of the forearm may be conducted by assessing the radial and ulnar pulses as well as sensory and motor function of the median, radial, and ulnar nerves. A neurovascular exam is used to assess the radial and ulnar arteries and to rule out any deficits in nerve function that may have been a result of the fracture. 

Radiographic imaging of the forearm, most commonly with the use of an X-ray and sometimes a CT scan, may be performed in order to visualize the forearm, rule out additional existing injuries, and confirm diagnosis of the distal ulna fracture. Standard radiographs may include anterior-posterior, lateral and oblique views of the forearm.

Depending on the severity of the distal ulna fracture, treatment may involve conservative or surgical interventions. In some cases, conservative measures can be used to completely treat the fracture. This is most common amongst children with distal ulna fractures and sometimes amongst adults with stable, isolated ulnar shaft fractures. Conservative treatment involves the application of a cast or functional brace to the affected forearm for approximately 4-6 weeks while avoiding any weight bearing. During this time, a medical professional will closely follow progress with the use of X-rays and physical exams to ensure healing. After cast removal, physical therapy, routine physical examinations, and gradual weight bearing may occur in order to restore a full range of motion in the affected forearm.

In most adults with a distal ulna fracture as well as in individuals with complex or open fractures, a surgical approach may be required. The type of approach is dependent on the affected bones and complexity of the fracture but can include an open reduction internal fixation in which a medical professional makes an incision in the forearm to reach the fractured bone and moves it back to its original position. External fixation is another surgical approach, which involves the external application of plates and screws into the forearm bone(s) to achieve stability of the fracture. Intramedullary nailing is another surgical technique involving the insertion of a metal rod across a fractured bone in order to provide support. Surgical treatment of open fractures commonly involves urgent bone realignment, wound irrigation, and the use of antibiotics to prevent infection.

After surgery, the forearm is commonly put into a splint or cast for comfort and protection, and individuals will need to avoid weight bearing for six weeks. Range of motion exercises are encouraged after one week of the initial fracture treatment under the supervision of a medical professional alongside close monitoring of the healing process through images and physical exams.