Review Question - QID 3173

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Isolated Ulnar Shaft Fracture Treatment Nonoperative QID: 3173 (OBQ10.85)

QID 3173 (Type "3173" in App Search)

A 25-year-old female sustains the isolated fracture seen in Figure A. The patient elects to have nonoperative management. When compared to operative treatment, which of the following is true of the clinical outcome following nonoperative management?

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Long arm cast immobilization is necessary with nonoperative management

16%

295/1805

Twenty degree loss of forearm rotation is expected with nonoperative management

112/1805

Loss of wrist motion is expected with nonoperative management

33/1805

Loss of elbow motion is expected with nonoperative management

41/1805

Equivalent clinical outcomes

73%

1312/1805

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The clinical presentation is consistent for an isolated ulnar fracture, or "night stick" fracture. For minimally displaced and angulated fractures, nonoperative management has equivalent clinical outcomes to surgical treatment.

Isolated ulnar shaft fractures with greater than 10 degrees of angulation or 50% displacement can result in loss of forearm rotation if treated nonoperatively. For minimally displaced fracture, nonoperative treatment results in union with good function. Time to union has been found to be greater in nonoperative groups, but clinical outcomes equivalent.

Pollock et al. compared two patient groups treated with short term immobilization or long term cast treatment and found no significant difference between wrist and elbow motion between the two groups. The short term immobilization group in their study had a shorter time to union and lower non union rate as well.