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 Fracture Types

• Distal radius fractures
  • Colles' fracture
  • Smith fracture
  • Barton fracture
  • Radial styloid fracture
  • Distal radioulnar joint disruption
• Radia ulna fracture
• Isolated radius fracture (proximal)
• Isolated ulna fracture (i.e. nightstick)
• Monteggia fracture-dislocation
• Galeazzi fracture-dislocation
• Forearm fracture (peds)

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

Immobilization

• Splint

Disposition

• If splinted and stabilized, can be discharged after consultation with Ortho
• Admit for:
  • Open fracture
  • Signs of neurovascular injury
  • Concern for compartment syndrome

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

• Forearm Fracture