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Distal Ulnar Fractures

Categories
  • Hand
  • Joint/Tendon
Tags
  • Hand injury
Hand

Upper Limb Anatomy

Right shoulder and arm, posterior view
Right shoulder and arm, posterior view

Right shoulder and arm, posterior view

Normal Upper Limb Anatomy
Triceps Brachii Muscle
Upper Limb Anatomy (Arm)
Muscles of the Forearm
Muscles of the Forearm
Upper Limb Anatomy (Nerve)
Medial aspect of right forearm

Medial aspect of right forearm

Left Brachial plexus

Left Brachial plexus

Nerves Posterior to Elbow Joint

Posterior view of right elbow

Posterior view of right elbow

Blood supply around the elbow joint

Blood supply and anastomosis

Blood supply and anastomosis around the right elbow. Anterior view

Elbow Joint

Elbow joint structural stability structures

Elbow joint structural stability structures

Left Arm

Left arm
Left arm
Humerus

Distal Humerus Biomechanics

The triangular structure of distal humerus at elbow joint provides structural strength.

Anterior view right distal humerus bone

Anterior view right distal humerus bone

Rotation around throchlear axis

The elbow joint is a hinge joint with axis of rotation around throchlear axis

Extensor muscles

Extensor muscles

Resisted finger flexion

Flexor muscles

Bone Structure
Haversion bone system

Haversion bone system

Distal Ulnar Fractures

Fractures of the distal ulnar head or ulnar styloid process can disrupt the stability and congruency of the distal radioulnar joint (DRUL) and therefore affect the articulation of the distal radioulnar and ulnocarpal (wrist) joints.

Distal radioulnar joint

Distal radioulnar joint:

The distal ulnar joint primary function is a weight-bearing joint. Radioulnar ligaments attachment to the ulnar fovea and base of ulnar styloid process.

AO Classification for distal ulnar fractures

AO Classification for distal ulnar fractures

Surgery for Distal Ulnar Fracture

Surgery for distal ulnar fracture

Structures at Risk with Surgery Approach to Distal Ulnar

Fractures of the distal ulnar head or ulnar styloid process can disrupt the stability and congruency of the distal radioulnar joint (DRUL) and therefore affect the articulation of the distal radioulnar and ulnocarpal (wrist) joints.

Dorsal branch of Ulnar nerve

Surgery Technique

Surgery

Surgery Technique Principles for Distal Ulnar ORIF

Surgery technique principles for distal ulnar ORIF

Post Operative Rehabilitation

  • Rigid fixation: arm sling for 7-10 days then elbow range of motion, non-weight bearing
  • Suboptimal fixation may require extended splintage
  • Strengthening exercises after fracture union
Arm sling

Arm sling

Hand grip exercises with arm in splint

Hand grip exercises with arm in splint

Forearm strength exercise

Download ASSIC Performance Fingerprint or Strength & Conditioning apps for rehab guideline routines or create own under professional supervision

apple app store  google play store

References

  1. A comparative Biomechanical Analysis of 2 Double-Row, Distal Triceps Tendon Repairs. Matthew A Dorweiler, Rufus O Van Dyke, Robert C Siska, Michael A Boin and Mathew J DiPaola. The Orthopaedic Journal of Sports Medicine May 2017, 5(5): 23259671177080.
  2. Traumatic elbow injuries: what the orthopedic surgeon wants to know. Sheehan S.E. Radiographics 33(3(: 869-888.
  3. A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Johnston GW. Ulster Med J 31: 51-56.
  4. Management of severely comminuted distal radius fractures. David M Brogan, Marc J Richard, David Ruch, Sanjeev Kakar. J Hand Surg Am. 2015 Sep; 40(9): 1905-14.
  5. Surgical management for olecranon fractures in adults: a systematic review and meta-analysis. Koziarz A, Woolnough T, Oitment C, Nath S, Johal H. Orthopedic. 2019 Mar 1;42(2): 75-82.
  6. Classifications in Brief: Mayo classification of olecranon fractures. Sullivan CW, Desai K. Clin Orthop Relat Res. 2019 Apr;477(4): 908-910.
  7. Elbow fractures. Midtgaard KS, Ruzbarsky JJ, Hackett TR, Viola RW. Clin Sports Med. 2020 Jul;39(3): 623-636.
  8. Comparison of outcome between nonoperative and operative treatment of medial epicondyle fractures. Petra Grahn, Tero Hämäläinen, Yrjänä Nietosvaara, Matti Ahonen. Acta Orthop. 2021 Feb;92(1): 114-119.
  9. A narrative review on avulsion fractures of the upper limb and lower limbs. Christopher Vannabouathong, Olufemi R Ayeni, Mohit Bhandari. Clin Med Insights Arthritis Musculoskelet Disord. 2018;11: 1179544118809050.
  10. Outcome after ORIF of capitellar and trochlear fractures. JH Dubberley, KJ Faber, JC Macdermid, SD Patterson, GH King. J Bone Joint Surg Am. Vol. 88 2006: 46-54.
  11. Coronal plane partial articular fractures of the distal humerus: current concept in management. DE Ruchelsman, NC Tejwani, YW Kwon, KA Egol. J Am Acad Orthop Surg. Vol 16 2008: 716-728.
  12. Complex elbow dislocations and the “terrible triad” injury. Allistair D R Jones, Robert W Jordan. Open Orthop J. 2017 Nov 30;11: 1394-1404.

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