Ulna fracture

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Ulna fracture
Monteggia Fracture.jpg
Monteggia Fracture (type of ulna fracture)
Types
  • Nightstick fracture [1]
  • Monteggia fracture [2]
  • Galeazzi facture [2]

An ulna fracture is a break in the ulna bone, one of the two bones in the forearm. [2] It is often associated with a fracture of the other forearm bone, the radius. [1] [3]

Contents

An ulna fracture can be a single break as in a so called nightstick fracture, which can be caused by someone being hit on the inside of the forearm often by a stick, notably when they are holding their arm up to protect their head from injury. [2] [4] The ulna bone can also break after falling on the forearm or falling on an outstretched arm. [2]

Ulna fractures are more common in both men and women before age 40 and women after age 60. Adolescents who play sports are at higher risk. [5]

Cause

An ulna fracture can be a single break as in a so called "nightstick fracture", which can be caused by someone being hit on the inside of the forearm often by a stick, notably when they are holding their arm up to protect their head from injury. [2] [4] An ulna fracture can also result from falling on the forearm or falling on an outstretched arm. [2]

Other causes of ulna fractures include sporting injuries, road traffic incidents, falls from a height, and conditions such as osteoporosis and potentially both primary and secondary cancer. [5]

Diagnosis

The diagnosis of an ulna fracture is made after taking the persons history, which usually includes a history of forearm pain following trauma, and then examining the injured forearm followed by an x-ray of the relevant part. [5]

Types

Fractures of the ulna can occur at different levels of the bone: near the wrist, in the middle or near the elbow. [2] The fracture may be confined to the ulna or accompanied with damage to the radius or the wrist or elbow joints. [2]

Treatment

If the fracture is not displaced, is stable, and is not associated with another fracture, it may be treated with a cast for around five to six weeks. [2] During the recovery period healing can be followed up with x-rays. [2] Heavy lifting should be avoided. [2] After the cast has been removed exercises are encouraged and full strength is regained over time. [2] Treatment may also be with splinting and early movement. [1]

When there is a displaced fracture and also when the radioulnar joints are involved an operation is often performed, using either flexible rods or screws and plates in order to reduce the fracture and immobilise the bone. [2]

Epidemiology

Ulna fractures are more common in both men and women before age 40 and women after age 60, which is related to osteoporosis. Adolescents who play sports are also particularly at risk of an ulna fracture. [5]

History

Early 20th century police truncheons (nightsticks) in the Edinburgh Police Centre Museum Edinburgh police truncheons (19thC).JPG
Early 20th century police truncheons (nightsticks) in the Edinburgh Police Centre Museum

The term "nightstick fracture" originated from the notion that a person hit by a police truncheon would hold their arms up to protect their heads from injury. Historically they were treated without surgery, but this resulted in a high risk of the broken parts not joining properly, unless the broken parts were generally aligned and the skin intact. [7]

Related Research Articles

<span class="mw-page-title-main">Arm</span> Proximal part of the free upper limb between the shoulder and the elbow

In human anatomy, the arm refers to the upper limb in common usage, although academically the term specifically means the upper arm between the glenohumeral joint and the elbow joint. The distal part of the upper limb between the elbow and the radiocarpal joint is known as the forearm or "lower" arm, and the extremity beyond the wrist is the hand.

<span class="mw-page-title-main">Ulna</span> Medial bone from forearm

The ulna is a long bone found in the forearm that stretches from the elbow to the smallest finger, and when in anatomical position, is found on the medial side of the forearm. That is, the ulna is on the same side of the forearm as the little finger. It runs parallel to the radius, the other long bone in the forearm. The ulna is usually slightly longer than the radius, but the radius is thicker. Therefore, the radius is considered to be the larger of the two.

The forearm is the region of the upper limb between the elbow and the wrist. The term forearm is used in anatomy to distinguish it from the arm, a word which is used to describe the entire appendage of the upper limb, but which in anatomy, technically, means only the region of the upper arm, whereas the lower "arm" is called the forearm. It is homologous to the region of the leg that lies between the knee and the ankle joints, the crus.

<span class="mw-page-title-main">Radius (bone)</span> One of the two long bones of the forearm

The radius or radial bone is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna. The ulna is usually slightly longer than the radius, but the radius is thicker. Therefore the radius is considered to be the larger of the two. It is a long bone, prism-shaped and slightly curved longitudinally.

<span class="mw-page-title-main">Colles' fracture</span> Medical condition

A Colles' fracture is a type of fracture of the distal forearm in which the broken end of the radius is bent backwards. Symptoms may include pain, swelling, deformity, and bruising. Complications may include damage to the median nerve.

<span class="mw-page-title-main">Bone fracture</span> Physical damage to the continuity of a bone

A bone fracture is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.

<span class="mw-page-title-main">Distal radius fracture</span> Fracture of the radius bone near the wrist

A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Symptoms include pain, bruising, and rapid-onset swelling. The ulna bone may also be broken.

<span class="mw-page-title-main">Smith's fracture</span> Medical condition

A Smith's fracture, is a fracture of the distal radius.

<span class="mw-page-title-main">Pulled elbow</span> Medical condition

A pulled elbow, also known as nursemaid's elbow or a radial head subluxation, is when the ligament that wraps around the radial head slips off. Often a child will hold their arm against their body with the elbow slightly bent. They will not move the arm as this results in pain. Touching the arm, without moving the elbow, is usually not painful.

<span class="mw-page-title-main">Galeazzi fracture</span> Medical condition

The Galeazzi fracture is a fracture of the distal third of the radius with dislocation of the distal radioulnar joint. It classically involves an isolated fracture of the junction of the distal third and middle third of the radius with associated subluxation or dislocation of the distal radio-ulnar joint; the injury disrupts the forearm axis joint.

<span class="mw-page-title-main">Distal radioulnar articulation</span>

The distal radioulnar articulation is a synovial pivot joint between the two bones in the forearm; the radius and ulna. It is one of two joints between the radius and ulna, the other being the proximal radioulnar articulation. The joint features an articular disc, and is reinforced by the palmar and dorsal radioulnar ligaments.

<span class="mw-page-title-main">Triangular fibrocartilage</span> Anatomical feature in the wrist

The triangular fibrocartilage complex (TFCC) is formed by the triangular fibrocartilage discus (TFC), the radioulnar ligaments (RULs) and the ulnocarpal ligaments (UCLs).

<span class="mw-page-title-main">Monteggia fracture</span> Medical condition

The Monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius. It is named after Giovanni Battista Monteggia.

<span class="mw-page-title-main">Humeroradial joint</span>

The humeroradial joint is the joint between the head of the radius and the capitulum of the humerus, is a limited ball-and-socket joint, hinge type of synovial joint.

<span class="mw-page-title-main">Humerus fracture</span> Medical condition

A humerus fracture is a break of the humerus bone in the upper arm. Symptoms may include pain, swelling, and bruising. There may be a decreased ability to move the arm and the person may present holding their elbow. Complications may include injury to an artery or nerve, and compartment syndrome.

<span class="mw-page-title-main">Elbow</span> Joint between the upper and lower parts of the arm

The elbow is the region between the upper arm and the forearm that surrounds the elbow joint. The elbow includes prominent landmarks such as the olecranon, the cubital fossa, and the lateral and the medial epicondyles of the humerus. The elbow joint is a hinge joint between the arm and the forearm; more specifically between the humerus in the upper arm and the radius and ulna in the forearm which allows the forearm and hand to be moved towards and away from the body. The term elbow is specifically used for humans and other primates, and in other vertebrates forelimb plus joint is used.

<span class="mw-page-title-main">Supracondylar humerus fracture</span> Medical condition

A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. In children, many of these fractures are non-displaced and can be treated with casting. Some are angulated or displaced and are best treated with surgery. In children, most of these fractures can be treated effectively with expectation for full recovery. Some of these injuries can be complicated by poor healing or by associated blood vessel or nerve injuries with serious complications.

The Essex-Lopresti fracture is a fracture of the radial head of the forearm with concomitant dislocation of the distal radio-ulnar joint along with disruption of the thin interosseous membrane which holds them together. The injury is named after Peter Essex-Lopresti who described it in 1951.

The Hume fracture is an injury of the elbow comprising a fracture of the olecranon with an associated anterior dislocation of the radial head which occurs in children. It was originally described as an undisplaced olecranon fracture, but more recently includes displaced fractures and can be considered a variant of the Monteggia fracture.

<span class="mw-page-title-main">Olecranon fracture</span> Medical condition

Olecranon fracture is a fracture of the bony portion of the elbow. The injury is fairly common and often occurs following a fall or direct trauma to the elbow. The olecranon is the proximal extremity of the ulna which is articulated with the humerus bone and constitutes a part of the elbow articulation. Its location makes it vulnerable to direct trauma.

References

  1. 1 2 3 4 Cai, X.-Z.; Yan, S.-G.; Giddins, G. (n.d.). "A systematic review of the non-operative treatment of nightstick fractures of the ulna". The Bone & Joint Journal. 95-B (7): 952–959. doi:10.1302/0301-620X.95B7.31669. ISSN   2049-4408. PMID   23814249.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 "Ulna and Radius Fractures (Forearm Fractures)". www.hopkinsmedicine.org.
  3. 1 2 Richards, Todd A.; Deal, D. Nicole (2014). "Distal ulna fractures". The Journal of Hand Surgery. 39 (2): 385–391. doi:10.1016/j.jhsa.2013.08.103. ISSN   1531-6564. PMID   24411292.
  4. 1 2 "Nightstick fracture (ulna) | Radiology Reference Article | Radiopaedia.org". Radiopaedia. Retrieved 6 December 2020.
  5. 1 2 3 4 Small, Roy F.; Yaish, Amjad M. (2020). "Radius and Ulnar Shaft Fractures". StatPearls. StatPearls Publishing.
  6. Mohindra, Mukul; Jain, Jitesh Kumar (2017). "20. Synopsis of orthopaedics". Fundamentals of Orthopedics. JP Medical Ltd. p. 495. ISBN   978-93-5270-132-2.
  7. Davis, Donald D.; Kane, Steven M. (2020), "Nightstick Fracture", StatPearls, StatPearls Publishing, PMID   32310411 , retrieved 22 December 2020