Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Chapter 1
- Chapter 2
- Chapter 3
- Section I Fractures of the proximal ulna
- Section II Fractures of the ulnar shaft
- Section III Fractures of the distal ulna
- Chapter 4
- Chapter 5
- Chapter 6
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Section III - Fractures of the distal ulna
from Chapter 3
Published online by Cambridge University Press: 05 February 2015
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Chapter 1
- Chapter 2
- Chapter 3
- Section I Fractures of the proximal ulna
- Section II Fractures of the ulnar shaft
- Section III Fractures of the distal ulna
- Chapter 4
- Chapter 5
- Chapter 6
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
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.
- Type
- Chapter
- Information
- Practical Procedures in Orthopaedic Trauma Surgery , pp. 56 - 59Publisher: Cambridge University PressPrint publication year: 2006