MANUAL MINORS
An isolated ulnar shaft fracture, also known as a “nightstick fracture” or “defensive fracture,” involves a break in the ulna without affecting the radius. It typically occurs due to direct trauma to the forearm, such as a blow or a fall.
This injury presents with localised pain, swelling, and occasionally deformity along the ulna. In severe cases, there may be difficulty moving the forearm and wrist.
Diagnosis
Diagnosis is made through a physical examination, revealing pain and swelling along the medial aspect of the forearm. Anteroposterior and lateral X-rays of the forearm confirm the fracture, showing its location and type. In complex cases, a CT scan may be required to evaluate the fracture’s extent and to plan treatment.
Differential Diagnosis
Condition | Distinctive Characteristics |
|---|---|
Monteggia fracture | Ulna fracture with dislocation of the radial head, with pain and deformity at the elbow. |
Fracture of both forearm bones | Affects both the radius and ulna, with more generalised pain and pronounced deformity. |
Distal radius fracture | Involves the distal portion of the radius, with pain near the wrist. |
Wrist sprain | Localised pain in the wrist without visible fractures on X-rays. |
Emergency Management
In the emergency setting, initial management involves immobilising the forearm with a long splint or cast to prevent movement and stabilise the fracture. Pain relief should be provided with analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). For displaced fractures, urgent reduction may be necessary to align the bone fragments properly.
Definitive Treatment
Non-displaced fractures can be managed conservatively with immobilisation in a cast for 4 to 6 weeks. Displaced, unstable, or comminuted fractures require surgical treatment with open reduction and internal fixation using plates and screws to ensure proper alignment and healing. Post-immobilisation physiotherapy is essential for restoring function to the forearm and wrist.
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