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MINERVA ORTOPEDICA E TRAUMATOLOGICA
Rivista di Ortopedia e Traumatologia
Minerva Ortopedica e Traumatologica 2015 June;66(3):123-31
Treatment of isolated ulnar fractures in adults with a new intramedullary nail
Köse A., Aydin A., Ezirmik N., Topal M., Can C. E.
Department of Orthopaedics and Traumatology, Atatürk University Medical Faculty, Erzurum, Turkey
AIM: The aim of this paper was to evaluate the outcomes of treatment of isolated ulnar fractures in adults with a new intramedullary nail.
METHODS: Seventeen patients (one with bilateral ulnar fracture) were included in this study. Fifteen patients (88.2%) were male and 2 (11.8%) female. Mean age of the patients was 38.3 (range: 23 to 58) years. Six patients (33.3%) had fractures in their right ulna, whereas in 12 patients (66.6%) the fracture was on the left side. Mechanism of injury was: fall in 5 cases (29.4%), traffic accident in 7 (41.2%), work-related accident in 2 (11.8%), and assault in 3 (17.6%). Three patients (17.6%) had open fractures. The patients were operated in an average of 17.17 (range: 0 to 48) hours following their presentation. Patients were followed-up for a mean of 20.9 (range 12-29) months. The Mann-Whitney U test and Spearman’s correlation test were used in the statistical analysis of the data.
RESULTS: Mean time to union was 10.94 (range: 8 to 20) weeks. Grip strength of the treated forearm was 59.27 (range: 40 to 98) kgw, and of the normal forearm 65.62 (range: 42 to 108) kgw. Mean degree of supination of the treated forearm was measured as 76.7 (range: 68 to 80) degrees, whereas mean pronation was measured as 86.29 (range: 76 to 90) degrees. Mean DASH Score of the patients was 9.9 (range: 4 to 32.5). Patients were exposed to intraoperative radiation for a mean of 0.8 (range: 0.5 to 2) minutes. No implant failure, mechanic irritation, implant breakage or radioulnar synostosis, non-consolidation or delay in consolidation was observed in any patient. Thirteen patients (76.5%) had excellent and 4 (23.5%) good results according to Grace-Eversmann criteria based on the functionality of the extremity and the degree of the union.
DISCUSSION: Our results suggest that intramedullary nailing is an alternative method for the treatment of isolated ulnar fractures, as it has good cosmetic outcomes, enables early mobilization, allows for closed application with short operative time and produces similar rates of union to those of plate osteosynthesis.