124 Nightstick Fractures: To Fix or Not to Fix?

Abstract

Abstract Background A nightstick fracture is an isolated fracture of the ulnar shaft. Non-operative treatment is preferred for simple, non-displaced fractures (<5mm displaced or <50% translation). However, these fractures are associated with a high non-union risk, hence there is a clinician bias towards internal fixation. Aim To review outcomes of treatment of non-displaced nightstick fractures in our unit Methods: Between 2015 and 2020 we identified 90 appropriate patients. 67 patients were treated non-operatively; 23 had surgery. Outcome measures included radiological healing, functional recovery, and complications. Results The mean healing time was similar between the two groups (10 weeks in the non-operative group; 9 weeks in the operative group). The complication rate was similar (26.9% in the non-operative group; 26.1% in the operative group). Following presentation of our findings, we re-audited our nightstick fracture management. Between 2020 and 2021, we identified 19 patients. 16 were treated non-operatively; 3 patients had surgery. This translated to an increase in the proportion of patients managed non-operatively from 74% to 84%. Conclusions With a simple presentation on the outcomes following operative versus non-operative management, we increased the proportion of patients not having surgery. Of the 12 patients who experienced non-union, 6 opted for surgery later, of which only 1 patient had persistent non-union. Offering surgery at the 6-week review if needed provides patients with more time, without adversely affecting their functional outcome. This study advocates the use of non-operative management for non-displaced nightstick fractures initially. The 6-week review could be used to discuss any change in management.