Right shoulder and arm, posterior view
Distal Ulnar Fractures
Upper Limb Anatomy
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
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:
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
- 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.
- Traumatic elbow injuries: what the orthopedic surgeon wants to know. Sheehan S.E. Radiographics 33(3(: 869-888.
- 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.
- 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.
- 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.
- Classifications in Brief: Mayo classification of olecranon fractures. Sullivan CW, Desai K. Clin Orthop Relat Res. 2019 Apr;477(4): 908-910.
- Elbow fractures. Midtgaard KS, Ruzbarsky JJ, Hackett TR, Viola RW. Clin Sports Med. 2020 Jul;39(3): 623-636.
- 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.
- 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.
- 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.
- 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.
- Complex elbow dislocations and the “terrible triad” injury. Allistair D R Jones, Robert W Jordan. Open Orthop J. 2017 Nov 30;11: 1394-1404.
