1/1/2024 0 Comments Acute oblique fractureThe ulnar styloid is a bony protrusion on the distal aspect of the ulnar head and is the attachment site for the superficial dorsal and palmar radioulnar ligaments. The ulna is the medial forearm bone, and it narrows distally. The major landmarks of the distal ulna are the metaphysis, styloid, and head. Biomechanically, the distal ulna acts as a stationary object for the radius to move around. This arrangement causes various load changes on the wrist depending on the grip and degree of pronation-supination. The ulnocarpal joint carries approximately 20% of the load capacity when in a neutral position. Support structures of the wrist, the triangular fibrocartilage complex (TFCC), and the distal radioulnar joint (DRUJ) are also commonly injured. Proper treatment must be provided as the ulnar epiphyseal plate is responsible for up to 80% of ulna growth. Isolated ulna fractures of the styloid and metaphysis are rare. ![]() Isolated ulnar physeal injuries are uncommon and have a greater propensity for early growth plate arrest. However, two recent retrospective studies failed to demonstrate any specific correlation between distal ulnar shaft fractures and abuse in children. Other less common mechanisms involve extreme supination or pronation. Healthcare providers should always maintain a high index of suspicion for possible abuse with any upper extremity fracture presenting with an unclear mechanism of injury, as they have been tied to intimate partner violence. A nightstick fracture (isolated ulnar shaft fracture) is usually the result of a direct blow to the ulna while a person is attempting to shield themselves with their arms. Isolated fractures of the distal ulna occur without an accompanying radius injury. Distal ulnar metaphyseal fractures occur within 5 cm of the dome of the ulnar head only 5% of distal radius fractures present with this associated injury. The least common presentation is an ulnar head fracture, which is a cause of wrist instability. The ulna styloid is the most fractured part of the ulna and is found in 80% of intraarticular distal radius injuries. High energy mechanisms also increase the likelihood of a simultaneous distal ulna fracture. The opposite is true of younger patients who suffer intraarticular injuries from high-impact trauma. In older individuals, the fracture pattern is usually extraarticular from low-energy causes. ![]() The predominant wrist position is dorsiflexion. By equipping healthcare professionals from diverse disciplines with an enhanced understanding of distal ulnar fracture management, this review aims to optimize treatment decisions and outcomes while mitigating the risks associated with inadequate comprehension of this injury's nuances.īoth distal ulna and radius fractures are usually the results of a fall on an outstretched hand (FOOSH). The course explores the complexities surrounding distal ulna fractures, offering insights into scenarios necessitating surgical intervention to prevent complications such as malunion and compromised hand function. Highlighting the necessity of surgical correction for the radius before addressing the ulna, the course navigates through nuanced treatment approaches, advocating conservative management based on individual patient considerations like age, activity level, and expectations. Targeting first responders, physicians, and support staff, this course emphasizes the comprehensive management of distal ulnar fractures alongside radial injuries. Distal ulnar fracture is a prevalent upper extremity injury frequently encountered in emergency departments.
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