The typical ulna fracture occurs as a result of an object impacting the forearm. The term for an isolated ulna fracture is “nightstick fractures” because it commonly occurs as a result of being struck 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. The following case illustrates this point.
Another indication is a segmental fracture with gross instability of the forearm. These are usually higher energy injuries such as pedestrians hit by a car or falls from significant height. The ulna is generally repaired with a long, straight plate. There is over 40 years of clinical experience in the literature suggesting that the healing rate of these fractures with standard implants is 94-96%. Surgical repair takes approximately involves realigning the bone and holding it with plates and screws. After surgery patients are immobilized in a splint for about 2 weeks. Following splint removal, it is important to begin moving the elbow and wrist as tolerated to avoid stiffness.
The plates can cause irritation of the soft tissues once the swelling subsides, but rarely require removal. Unlike many other areas of the body, removing the screws can weaken the bone in the forearm and secondary fractures at the site of previous hardware removal has occurred. Understandably, this is a devastating complication and precludes removal unless there is a strong indication for removing the plate (active infection, loss of fixation).