Locked Intramedullary Nailing versus Compression Plating for Stable Ulna Fractures: A Comparative Study.

Vito Pavone,Umberto Sueri,Alpesh Kothari,Andrea Vescio,Giuseppe Mobilia,Marco Ganci,Gianluca Testa,Giacomo Papotto

doi:10.3390/jfmk6020046

Abstract

Background: Isolated ulna shaft fractures (USFs) are a relatively uncommon, but significant, injury. For unstable USF treatment, open reduction and internal fixation (ORIF) is the gold standard, while for stable USFs several procedures were described. The aim of this study is to compare the outcomes in patients with stable USFs treated by either ORIF or intramedullary nail (IMN). Methods: According to their surgical treatment, 23 eligible USF-affected patients were divided into ORIF (14 subjects) and IMN (nine subjects) groups. The subjects underwent postoperative clinical follow-up at 1, 3, 6, and 12 months, which included calculation of the Disabilities of the Arm, Shoulder and Hand (DASH) score and radiological follow-up. Time to union, time to return to sporting and occupational activities, duration of physical therapy, and surgical complications were recorded. Results: DASH scores improved in both groups at the 6-month follow-up (p < 0.001). The IMN cohort recorded better DASH scores at the 1- and 3-month follow-ups, while similar results were reported at the 6- and 12-month follow-ups. Earlier fracture union (p = 0.001) and return to sporting activities and work (p = 0.002) were seen in the IMN group, compared with the ORIF group. No complications were observed in the IMN group. Conclusions: The surgical treatment of isolated USF results in excellent functional and radiographic outcomes. IMN may be preferable, compared with ORIF, due to its faster recovery time, expedited union, and reduced likelihood of complications.

Highlights

Isolated ulna shaft fractures are a relatively uncommon, but significant, injury with an estimated incidence of 0.2 cases per 1000 population, representing 14% of adult forearm fractures [1]
Intramedullary nailing has the potential benefit of a reduction in operative morbidity due to its less invasive nature and improved fracture biology, compared with open reduction and internal fixation (ORIF), as the fracture site is left relatively undisturbed with no extra periosteal stripping
It was hypothesised that patients treated with intramedullary nail (IMN) would have a faster recovery, improved union rates, and reduced complications compared with those undergoing ORIF

Summary

Introduction

Isolated ulna shaft fractures are a relatively uncommon, but significant, injury with an estimated incidence of 0.2 cases per 1000 population, representing 14% of adult forearm fractures [1]. For unstable ulna shaft fractures, there is consensus that open reduction and internal fixation (ORIF) with a compression plate is the gold standard treatment [3]. It was hypothesised that patients treated with IMN would have a faster recovery, improved union rates, and reduced complications compared with those undergoing ORIF. The aim of this study is to compare the outcomes in patients with stable USFs treated by either ORIF or intramedullary nail (IMN). IMN may be preferable, compared with ORIF, due to its faster recovery time, expedited union, and reduced likelihood of complications

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Conclusion