Marlon O Coulibaly1, Clifford B Jones2, Debra L Sietsema2, Thomas A Schildhauer3. 1. Orthopaedic Research Fellowship, Grand Rapids Medical Education and Research Center, Grand Rapids, MI, USA; Ruhr-University Bochum, University Hospital Bergmannsheil GmbH, Department of Traumatology, Bochum, Germany. Electronic address: marlon.coulibaly@bergmannsheil.de. 2. Orthopaedic Associates of Michigan, Grand Rapids, MI, USA; Michigan State University, College of Human Medicine, Department of Surgery, Grand Rapids, MI, USA. 3. Ruhr-University Bochum, University Hospital Bergmannsheil GmbH, Department of Traumatology, Bochum, Germany.
Abstract
BACKGROUND: Adult isolated ulnar shaft fractures (IUSFs) are uncommon, and treatment remains controversial. The purpose of this study was to compare results of operative (reduction internal fixation (RIF)) and nonoperative treatment (NOT) in patients with IUSF. MATERIAL AND METHODS: A retrospective case-control analysis was undertaken on patients diagnosed with IUSF between 2002 and 2008 at a Level I teaching trauma center. Clinical outcomes consisted of complications and functional ability. RESULTS: Seventy patients had a mean age of 44.6 years (18-86) and a body mass index (BMI) of 27.9 (17-47). The mechanism of injury included high-energy injuries (60/70, 85.7%), low-energy falls (8/70, 11.4%), and sports (2/70, 2.9%). Treatment consisted of 33/70 (47.1%) NOT and 37/70 (52.9%) RIF. The AO/OTA fracture classification was 48 A1, 20 B2, and two C1. The level of activity (LOA) was 60 without restrictions, six with restrictions, and three who did not return to work. The function determined by range of motion was 55/70 (78.6%) full, 11 slightly limited, and one severely limited. A total of 14 nonunions (NUs) and 17 malunions (MUs) occurred. NOT was associated with NU (χ(2)=0.001) and MU (χ(2)=0.000), respectively. Fracture angulation ≥8° was related to the inability to return to previous LOA (ρ=0.406, p=0.001). Secondary displacement >2mm contributed to MU (R(2)=0.238, p=0.000) and NU (R(2)=0.076, p=0.021). NU was related to a minor functional result (ρ=0.315, p=0.009). CONCLUSIONS: IUSF treatment remains challenging in the adult population. Nonoperative treatment of displaced fractures produces a high risk of complications, and the fracture characteristics determine patient outcome. LEVEL OF EVIDENCE: Level III.
BACKGROUND: Adult isolated ulnar shaft fractures (IUSFs) are uncommon, and treatment remains controversial. The purpose of this study was to compare results of operative (reduction internal fixation (RIF)) and nonoperative treatment (NOT) in patients with IUSF. MATERIAL AND METHODS: A retrospective case-control analysis was undertaken on patients diagnosed with IUSF between 2002 and 2008 at a Level I teaching trauma center. Clinical outcomes consisted of complications and functional ability. RESULTS: Seventy patients had a mean age of 44.6 years (18-86) and a body mass index (BMI) of 27.9 (17-47). The mechanism of injury included high-energy injuries (60/70, 85.7%), low-energy falls (8/70, 11.4%), and sports (2/70, 2.9%). Treatment consisted of 33/70 (47.1%) NOT and 37/70 (52.9%) RIF. The AO/OTA fracture classification was 48 A1, 20 B2, and two C1. The level of activity (LOA) was 60 without restrictions, six with restrictions, and three who did not return to work. The function determined by range of motion was 55/70 (78.6%) full, 11 slightly limited, and one severely limited. A total of 14 nonunions (NUs) and 17 malunions (MUs) occurred. NOT was associated with NU (χ(2)=0.001) and MU (χ(2)=0.000), respectively. Fracture angulation ≥8° was related to the inability to return to previous LOA (ρ=0.406, p=0.001). Secondary displacement >2mm contributed to MU (R(2)=0.238, p=0.000) and NU (R(2)=0.076, p=0.021). NU was related to a minor functional result (ρ=0.315, p=0.009). CONCLUSIONS: IUSF treatment remains challenging in the adult population. Nonoperative treatment of displaced fractures produces a high risk of complications, and the fracture characteristics determine patient outcome. LEVEL OF EVIDENCE: Level III.