Fractures of the Ulnar Head

Indications

Fractures extending from the fovea to the radial cortex of the ulnar head metaphysic

Pitfall

These fractures may be comminuted such that fixation is not possible. Prepare the patient for both fixation of the fracture and either hemiresection or Darrach-type resection of the distal ulna.

Pearl

If reduction and fixation of the fracture is chosen, the fixation must be sufficiently secure to permit immediate forearm rotation.

Technique

Several forms of fixation should be available, including mini fragment plates, screws, and interosseous wire.

Incision is a gentle curve extending from the base of the fifth metacarpal to the extensor carpi ulnaris (ECU), ~2 cm proximal to the distal radioulnar joint (DRUJ) (Fig. 12-1A,B).
Expose the dorsal aspect of the DRUJ through fifth extensor compartment.
Create ulnarly based rectangular capsular flap to expose the ulnar head.
Assess comminution and the attachment of the triangular fibrocartilage complex (TFCC).
Reduce and provisionally stabilize the fracture with a tenaculum and pins, as needed.
Elevate the ulnar skin flap exposing the distal ulna in the interval between the ECU and flexor carpi ulnaris (FCU).