Ulnar Fracture

Description

An ulnar fracture is a complete or incomplete break of one of the bones of the forearm, the ulna, which extends from the elbow to the wrist. You can feel this bone under the skin along its length. This discussion does not include fractures of the elbow or wrist joints.

Common signs and symptoms

• Severe forearm pain at the time of injury

• Tenderness, swelling, and later bruising of the forearm; swelling and bruising that moves to the wrist and hand

• Visible deformity if the fracture is complete, and bone fragments separate enough to distort normal body contours (displacement)

• Numbness, coldness, or paralysis below the fracture, involving the forearm or hand, from pressure on or stretching of blood vessels or nerves (uncommon)

• Crepitation (crackling sounds) when the fractured area is touched

Causes

Ulnar fractures are usually the result of a direct blow or force to the forearm bone. Also, they can be due to an indirect stress from falling on an outstretched hand, a twisting injury, or a violent muscle contraction, although these mechanisms usually cause fractures to both bones or to just the radius, the other bone of the forearm.

Factors that increase risk

• Contact sports, such as football, rugby, soccer, martial arts, and hockey

• History of bone or joint disease

• Previous immobilization of the forearm

• Poor physical conditioning (strength, flexibility)

Preventive measures

• Appropriately warm up and stretch before practice and competition.

• Maintain appropriate conditioning that includes cardiovascular fitness and forearm strength, endurance, and flexibility training.

• Wear proper protective equipment, and ensure a correct fit.

Expected outcome

With appropriate treatment and normal alignment of the bones, healing can be expected in 6 to 8 weeks in adults and 4 to 6 weeks in children. Surgery may be necessary to realign fractures that are displaced.

Possible complications

• Nonunion (fracture does not heal)

• Malunion (bone heals in a bad position)

• Chronic pain, stiffness, loss of motion, or swelling of the elbow or wrist

• Excessive bleeding in the forearm, causing pressure and injury to nerves and blood vessels

• Heterotopic ossification (calcification of the soft tissues about the forearm)

• Injury to the nerves of the hand or wrist as a result of stretching from the fracture, causing numbness, weakness, or paralysis

• Shortening of the arm

• Loss of motion in the elbow or wrist

General treatment considerations

If the bone is in appropriate alignment, the initial treatment consists of ice and medication to help relieve pain. Immobilization by splinting, casting, or bracing for 4 to 6 or more weeks is recommended to protect the bones while they heal. Severe fractures, fractures that are displaced, and even nondisplaced fractures may require surgery to restore and maintain the joint to its normal position. Surgery usually includes repositioning the bones and holding them in place with rods, plates, screws, or pins. After immobilization (with or without surgery), stretching and strengthening of the injured and weakened joint and surrounding muscles are necessary because of the injury and the immobilization. These exercises are usually performed with the assistance of a physical therapist or athletic trainer. A splint or brace may allow an earlier return to sports with this fracture.

Medication

• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other over-the-counter pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician, and contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Stronger pain relievers may be prescribed as necessary. Use these only as directed, and take only as much as you need.

Cold therapy

Cold is used to relieve pain and reduce inflammation. It should be applied for 10 to 15 minutes every 2 to 3 hours as needed and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

When to call your doctor

• Pain, tenderness, or swelling worsens despite treatment.

• You experience pain, numbness, or coldness in your hand.

• A blue, gray, or dusky color appears in your fingernails.

• Any of the following occur after surgery: fever, increased pain, swelling, redness, drainage, or bleeding in the surgical area.

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