Distal Ulnar Fractures

Upper Limb Anatomy

Right shoulder and arm, posterior view

Medial aspect of right forearm

Left Brachial plexus

Nerves Posterior to Elbow Joint

Posterior view of right elbow

Blood supply around the elbow joint

Blood supply and anastomosis around the right elbow. Anterior view

Elbow joint structural stability structures

Left Arm

Distal Humerus Biomechanics

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

Anterior view right distal humerus bone

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

Extensor muscles

Flexor muscles

Haversion bone system

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:

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

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.

Surgery Technique

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

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

References

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Elbow fractures. Midtgaard KS, Ruzbarsky JJ, Hackett TR, Viola RW. Clin Sports Med. 2020 Jul;39(3): 623-636.
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