Ulna Nightstick Fractures

Ulna-FracturesThe typical ulna fracture occurs as a result of an object impacting the forearm. The common term for an isolated ulna fracture is “nightstick” because it occurs as a result of a direct blow with a blunt object. Isolated ulna fractures are generally treated without surgery.

Some ulna fractures do require surgical intervention. If the fracture is very close to the wrist, the joint between the ulna and radius (called the distal radio-ulnar joint) can be disrupted. If this disruption is neglected patients will develop chronic wrist pain and stiffness. X-ray views of the wrists can help determine if there is any involvement of the DRUJ. If there is a disruption, surgical treatment is typically recommended. The case below illustrates this point.

Fracture-ulna02Fracture-ulna01

The plates can cause irritation of the soft tissues once the swelling subsides, but we rarely recommend removal of the implants. Unlike many other areas of the body, removing the screws can weaken the bone in the forearm and patients have developed secondary fractures at the site of previous hardware removal. Understandably, this is a devastating complication and unless there is a strong indication for removing the plate (active infection, loss of fixation) we caution against taking the implants out.