Fixation of isolated ulnar shaft fracture: by open reduction and internal fixation with plate or percutaneous intramedullary nailing

Purpose of the study The authors report a study from a series of 113 adults treated by osteosynthesis in a seven year period, for an adult isolated ulnar shaft fracture by osteosynthesis. These patients were divided into two groups: 57 patients treated by open reduction and AO plate fixation (group n degrees 1), and 56 patients operated by percutaneous intramedullary nailing, according to Bohler technique, with a simple Kirschner pin suited into the medullary canal (group n degrees 2). Material and methods For this ulnar fracture, the proportion of men and women was equal, with an average age of 37 years, predominant on the left limb (61 per cent). The most common cause was direct trauma (71 per cent): Bohler's "parry fracture", followed by traffic accidents (14 per cent), and 6 per cent by falls. We never found, in this series, indirect fractures by fall on the hand palm, and never clinical or radiological objective signs for a suspected lesion of the proximal and distal joints. Both operative procedures are described, with a particular emphasis on the simplicity of the nailing technique. No immobilization, of any kind, was applied, and patients were allowed to start full movements of the wrist and elbow, immediately after surgery. Results There were no early post operative complications, but great differences in the evolution between both groups. In group n degrees 1, there was a 29,8 per cent complication rate, 47 per cent of this was considered as "major" including osteomyelitis, non union, plate breakage, screw loosening, refractures. Patients in group n degrees 2, suffered only a few "minor" complications. Functional and anatomical results were also better in group 2 with earlier return to work. Discussion Isolated fracture of the ulnar shaft in the adult is known as a problematic fracture which needs long time to unite and often ends in non union. If opinion varies between plaster or internal fixation, we have abandoned the conservative treatement for the osteosynthesis. In order to demonstrate that intramedullary nailing technique gives a "sufficient" fixation, the authors pointed out the biomechanical importance of soft tissues structure preservation. Conclusion Percutaneous intramedullary nailing of isolated ulnar shaft fractures in adult, is a simple and inexpensive technique, which gives predictable bone union, without particular complication and without drawbacks of other internal fixation techniques.