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Section III - Fractures of the distal ulna

from Chapter 3

Published online by Cambridge University Press:  05 February 2015

Peter V. Giannoudis
Affiliation:
St James's University Hospital, Leeds
Hans-Christian Pape
Affiliation:
University of Pittsburgh
Gregoris Kambouroglou
Affiliation:
John Radcliffe Hospital
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Summary

OPEN REDUCTION AND INTERNAL FIXATION (ORIF) FOR DISTAL ULNAR FRACTURES

Indications

  • Displaced isolated fractures of the distal ulna.

  • Fractures of the distal ulna associated with distal radius fractures.

Pre-operative assessment

Clinical assessment

  • High-energy fractures, often with an open wound over the ulnar fracture.

  • Ensure the injury is in isolation and the arm remains neurovascularly intact.

  • Specifically test for ulnar nerve impairment.

Radiological assessment

  • Ensure adequate views are available.

  • In complex fractures of the distal radius (Fig. 3.20) a CT scan may be helpful to delineate the injury and assist in reconstruction.

  • Displaced fractures must be reduced with simple means to avoid complications but also to facilitate further imaging.

  • Problems are often encountered related to the amount of fragmentationandthe quality of thebonein thehead of the ulna.

Operative treatment

Anaesthesia

  • General anaesthetic is preferred. In acute injuries the use of regional blocks is discouraged as it may mask underlying pressure phenomena or compartment syndrome.

Operative equipment

  • Use the mini-fragment set with 2.7mmscrews for fractures proximal to the distal radio-ulnar joint.Use a tension band for the most distal fractures.

  • In associated fractures of the distal radius with shortening, the small external fixator is also used as a reduction aid.

Set up and positioning

  • Hand table at 45°.

  • Imager intensifier.

  • Rolled up towel.

  • Surgeon on the head side of the table (Fig. 3.21).

  • Prescrub the limb.

  • Antibiotic prophylaxis and tourniquet if there are no contraindications.

  • Prepare the armto the elbow as occasionally it may be necessary to obtain a graft from the olecranon.

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Publisher: Cambridge University Press
Print publication year: 2006

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