Distal ulnar fracture with Distal radius fracture

Fracture mechanism
anatomy of ulna
anatomy of ulna and TFCC
distal ulnar fracture with distal radius fracture
Classification of ulnar fracture
Unlar styloid fracture
ulnar neck to distal diaphysis fracture
Fixation method
difficulty in fixation
Salvage procedure

 Distal ulnar fx

Axial  load of the hand 

80% through distal radius

20% through the ulna


Uncommon in isolation 

Isolated ulna Fx. : Nightstick fracture


Usually with distal radius Fx. -  5.6%

Mainly Styloid Fx. (60~70%)

Metaphysis : 5~6%  (old age)



Anatomy 

Anatomy 

Distal ulnar Fx with distal radius Fx 

combined with  5.6% of DRFx.


 Old age

poor quality and comm. of metaphyseal bone 

small distal fragment


Risk factor of reduction loss of DRFx.


Complication of DUFx.

Ulnar malunion (shortening, angulation)

LOM of DRUJ and radiocarpal joint.

arthritis, TFCC  problem

Classification

Biyani classification 

-> Intraarticular ? Extra articular?


AO classification

Q1 : Styloid

Q2 : Ulnar neck simple

Q3 : Ulnar neck comminuted

Q4 : Ulnar head

Q5 : Ulnar head and neck

Q6 : Shaft 






Ulnar styloid Fx.


Traditional : Base Fx. with 2mm displacement -> May be DRUJ injury -> Fixation 


Current : 1) No DRUJ instability 

                  2) DRF fixation performed


=> No difference between fixation and observation (JBJS 2009)


Nonunion : No functional deficit

(Injury 2014)

Ulnar neck ~ Distal diaphysis fx.

First, DRF fixation should be performed


Conservative management (JHS 2003, JHS 2009) 

No DRUJ instability 

Well aligned after fixation of radius



OP Ix 

Angulation > 10 degree

Ulnar shortening (Ulnar variance) > 3mm 

Translation in fracture surface > 1/3 

Instability :  Ulnar head dorsal subluxation > 50%


Fixation method of DUFx.

K-wire






Plate

Difficulty in fixation

Comminution (Small distal fragment)


Metaphyseal bone quality (With osteopenia)


Hardware impingement on ulnar head


Thin soft tissue 


Triangular shape of cross-sectional bone


Ulnar never dorsal sensory branch in volar plating

Salvage procedure


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