Isolated ulna fracture

Background

  • Also known as a "nightstick" fracture
    • Characteristic defensive fracture sustained when the patient tries to protect themselves from an overhead blow
  • Most often due to direct trauma

Clinical Features

  • Pain/swelling, deformity

Differential Diagnosis

Forearm Fractures

Evaluation

  • Assess distal pulse, motor, and sensation
  • 2-view forearm x-ray

Management

General Fracture Management

  • Acute pain management
  • Open fractures require immediate IV antibiotics and urgent surgical washout
  • Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
  • Consider risk for compartment syndrome
  • If any limitation to range of motion, orthopedics will often perform elbow arthrocentesis to remove hemarthrosis which is often present
    • The purpose of this is to see whether range of motion is restored after aspiration since if it is not, this may be an indication for surgery
    • This is generally not necessary to perform in the ED but can be done for patient comfort

Immobilization

Disposition

Specialty Care

  • Stable: short arm cast
  • Long arm posterior splint with 90 degrees of elbow flexion and the hand in a neutral position
  • Unstable: ORIF
    • >50% displacement
    • >10% angulation
    • Involvement of proximal 1/3

See Also

References