Thurs., 10/14/10 Upper Extremity, Paper #29, 3:19 pm OTA-2010
Results of 70 Consecutive Ulnar Nightstick Fractures
Marlon O. Coulibaly, MD1; Clifford B. Jones, MD2; Debra L. Sietsema, PhD2;
James R. Ringler, MD2; Terrence J. Endres, MD2;
1Grand Rapids Medical Education and Research Center, Grand Rapids, Michigan, USA;
2Orthopaedic Associates of Michigan. Michigan State University, Grand Rapids, Michigan, USA
Purpose: Adult isolated ulnar shaft fractures (IUSF) are uncommon and treatment remains controversial. The purpose of this study was to compare results of operative (RIF) and nonoperative (NOT) treatment in patients with IUSF.
Methods: A retrospective case-control analysis was undertaken on patients diagnosed with IUSF between 2002 and 2008 at a Level 1 teaching trauma center. Clinical outcomes consisted of complications and functional ability.
Results: 70 patients had a mean age of 44.6 years (range, 18-86) and body mass index (BMI) of 27.9 (range, 17-47). Mechanism of injury included high-energy injuries (60 [85.7%]), low-energy falls (8 [11.4%]), and sports (2 [2.9%]). AO/OTA fracture classification was 48 (68.6%) type A1, 20 (28.6%) B2, and 2 (2.9%) C1. Treatment consisted of 33 (47.1%) NOT and 37 (52.9%) RIF. NOT and RIF showed comparable healing time, but RIF required a shorter immobilization period (t = 4.557, P = 0.001). At final follow-up, level of activity (LOA) was 61 without restrictions, 6 with restrictions, and 3 did not return to work. Function determined by range of motion was 55 (78.6%) full, 10 slightly limited, 2 severely limited, and 3 missing data, and was similar between treatment groups (P > 0.05). 14 nonunions (NU) and 17 malunions (MU) occurred. NOT was associated with NU (χ2 = 0.001) and MU (χ2 < 0.001), respectively. Fracture angulation ≥8° was related to the inability to return to previous LOA (ρ = 0.406, P = 0.001). Secondary displacement >2 mm was related to MU (ρ = 0.488, p < 0.001) and weakly to an inferior functional result (ρ = 0.353, P = 0.003). NU was weakly related to an inferior functional result (ρ = 0.313, P = 0.010). Treatment did not associate with increasing severity of fracture pattern (P > 0.05). Injury severity did not relate to clinical or functional outcome (P > 0.05).
Conclusions: Despite improved understanding of functional anatomy and techniques, IUSF treatment remains challenging in the adult population. Fracture pattern and injury severity did not predict healing and outcome. However, nonoperative treatment of displaced fractures were at high risk for complications and fracture characteristics determined patient outcome.
Alphabetical Disclosure Listing (292K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.