Fractures of the Ulnar Neck

Fractures with metaphyseal comminution are particularly difficult to manage.

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

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. 13-1A,B).
Expose the dorsal aspect of the ulnar head through the fifth extensor compartment.
Initial fixation via plate placed in the interval between the flexor carpi ulnaris (FCU) and extensor carpi ulnaris (ECU) just proximal to ulnar styloid (Fig. 13-2).
Ensure distal screw placement does not enter distal radioulnar joint using operative fluoroscopy (Fig. 13-3).
Span the fracture with a second plate placed 90 degrees to the first, on the dorsal surface of the distal ulna (Fig. 13-4).