Removal of all dressing, regardless of the presence of fracture, should be followed by complete restoration of function. If the case is first seen after the establishment of contracture, surgical measures will be necessary, and even then the restoration of function is usually only partial. The condition of the nerves should be determined and then the procedure most likely to give good results chosen. Myotomy may be performed, the nerves may be dissected out, the flexor tendons may be lengthened or the radius and ulna may be shortened. Passive motion and massage are most important following operation.
Surgical Anatomy — Isolated fracture of the lower end of the ulna is not a common injury and its importance is much less than fractures of the lower end of the radius. Uncomplicated fracture in this region is almost invariably due to direct violence. The lower end of the ulna is only slightly larger than the shaft above it and transverse stress is about the only type of strain to which it is subjected. It forms the center about which the lower end of the radius revolves during supination and pronation.
Symptoms — The symptoms accompanying isolated fracture of the lower end of the ulna are often surprisingly mild. There is local pain, tenderness, swelling and a variable degree of loss of function. Since the condition usually results from direct violence there will, as a rule, be evidences of the blow on the skin in this region. If the trauma is severe the condition may be compound.
Diagnosis — Fracture of the lower end of the ulna can, as a rule, be recognized without difficulty if the parts are carefully examined. There is no characteristic deformity and hence inspection alone is of little value. The broadening of the wrist seen in Colles' fracture is due to rupture of the triangular fibro-cartilage or to avulsion of the styloid (usually the latter) and is suggestive of fracture of the lower end of the ulna.
Treatment — This fracture is not a serious one as compared to other breaks in this region and reduction of the displacement is usually accomplished without difficulty. If the tendon of the extensor carpi ulnaris tends to displace the lower fragment, the hand should be treated in a position of dorsal flexion and adduction.
<Callout type="important" title="Critical Rule">Direct pressure may be exerted by pads of gauze secured in position by strips of adhesive plaster. This is not often indicated but when it is necessary to prevent backward deformity.</Callout>
Operative Treatment — Open treatment is rarely indicated in recent cases aside from compound conditions. When the fracture is open, it should be treated according to principles laid down under 'The Treatment of Compound Fractures and Luxations.' If deformity recurs or persists and cannot be controlled by ordinary methods, the fragments should be secured by internal fixation.
After-Treatment — The forearm should be frequently inspected during the first week or ten days. Undue constriction of the forearm is as dangerous here as in fractures of the shafts of the bones of the forearm and may lead to Volkmann's Contracture.
Key Takeaways
- Isolated fractures of the lower end of the ulna are less common and serious compared to those at the radius.
- Direct violence is a primary cause, leading to mild symptoms like pain, tenderness, swelling, and loss of function.
- Proper diagnosis involves careful examination as there's no characteristic deformity.
Practical Tips
- Careful inspection is crucial for diagnosing fractures without obvious deformities.
- Use gauze pads secured by adhesive plaster to apply direct pressure if necessary.
- Frequent inspection of the forearm during initial weeks prevents complications like Volkmann's Contracture.
Warnings & Risks
- Undue constriction can lead to serious complications such as Volkmann's Contracture.
- Direct palpation may cause further injury or pain, especially in compound fractures.
Modern Application
While the surgical methods described here are outdated, understanding the anatomy and symptoms of ulna fractures remains crucial for modern survival scenarios. Techniques like immobilization with splints still apply today, but advanced medical care should be sought immediately.
Frequently Asked Questions
Q: What is the primary cause of isolated fractures at the lower end of the ulna?
Isolated fractures of the lower end of the ulna are primarily caused by direct violence and result in mild symptoms such as pain, tenderness, swelling, and loss of function.
Q: Why is careful examination important for diagnosing these fractures?
Careful examination is crucial because there is no characteristic deformity associated with isolated fractures at the lower end of the ulna. Inspection alone is not sufficient to diagnose the condition accurately.
Q: What are some treatment methods mentioned in this chapter for managing ulna fractures?
Treatment includes immobilizing the forearm using a splint, applying direct pressure with gauze pads if necessary, and frequently inspecting the area during initial weeks to prevent complications like Volkmann's Contracture.