Treatment of isolated ulnar shaft fractures with short arm cast

Abstract

Objectives: isolated ulnar shaft fractures are rare injuries but union problems are common. Treatment with long arm cast and plate osteosynthesis has a potential risk of  nonunion and delayed union. In this study we aimed to discuss the radiological and clinical results of isolated ulnar shaft fractures, treated with short arm cast.

Methods: 13 patients treated with short arm cast in our clinic, were included to the study. Mean age of patients was 44. The etiologies of fracture were direct blow for five, fall for five and traffic accident for three patients. The radiographic evaluation was made according to ulnar shaft anatomic angle, ulnar variance at the wrist joint and presence of union. Clinical evaluation was made by Quick DASH  (Disabilities of Arm Shoulder and Hand) and Visual Analog Scale.

Results: MEan follow-up duration was 26.5 months. Among all patients  union was achieved. Mean union duration was6.15 weeks.  Mean Q-DASH score was 2.97. mean ulnar shaft anatomic angle was 1.8 degrees for at the time of fracture and 3.48 at the end of the union. At the end of the treatment, one patient had neutral ulnar variance , two positive and ten negative. Four patients had radiologic malunion.

Conclusion:the treatment results of short arm cast treatment of isolated ulnar shaft fractures are good. Patients had some sort of malunion but it had little effect on clinical results. Long arm cast should be used temporarily fort the treatment of isolated ulnar shaft fractures, not till the end of the treatment. 

Keywords

• Ulna
• isolated shaft fracture
• short arm cast
• conservative treatment

İzole ulna şaft kırıklarının kısa kol sirküler alçı ile tedavisi

Abstract

Amaç: İzole ulna krıkları nadir görülen kırıklardır ve kaynama gecikmesi nadir görülen bir durum değildir. Uzun kol alçı ile plaklı tespitte kaynama gecikmesi ve yetersiz kaynama sorunları ile karşılaşılabilmektedir. Biz bu çalışmamızda izole ulna kırığı olan ve kısa kol alçı ile tedavi ettiğimiz hastalarımızın klinik ve radyolojik sonuçlarını tartıştık.

Yöntem: kliniğimizde ulna diyafiz kırığı nedeniyle konservatif  tedavi ettiğimiz 13 hasta çalışmaya dahil edildi. Hastaların yaş ortalaması 44'tü; 6 hasta erkek, 7 hasta kadındı.  Hastalardan tümü kısa kol sirküler alçı ile takip edildiler. Kırıkların 2'si proksimal 1/3, 7’si orta, 4’ü distal yerleşimli izole ulna şaft kırığıydı. 5 hastada direkt darbe, 5 hastada düşme, 3 hastada ise araç içi trafik kazası sonucu kırık oluşmuştu.  Hastaların radyolojik değerlendirilmesinde ap  grafide ulna şaftının eğilme açıları, el bileği seviyesinde ulnar  varyans ve kaynama durumuna bakıldı. Hastaların klinik değerlendirilmesinde vizüel ağrı skalası, Q-DASH skorlamasına bakıldı.

Bulgular: Hastaların ortalama takip süresi 26.5 aydı. Tüm hastalarda kaynama elde edildi. Ortalama kaynama süresi 6.15 haftaydı.  Ortalama Q-DASH skoru 2.97 idi. Hastaların ap grafide ortalama ulna şaft açıları kırık anında ortalama 1.8 derece, kaynama sonunda 3.48 dereceydi. Tedavi sonunda el bilek ulnar varyans ortalama değeri 1 hastada nötral, 2 hastada pozitif, 10 hastada negatifti. 4 hastada radyolojik malunion saptanmıştı.

Sonuç: izole ulna şaft kırıkları kısa kol alçı ile tedavisi sonuçları iyidir. Belirli düzeyde malunion görülse de klinik üzerine etkisi yoktur. İzole ulna şaft kırıklarında uzun kol atel-alçı tespiti geçici kullanılmalı, tedavinin tamamında kullanılmamalıdır. 

Keywords

• Ulna
• izole şaft kırığı
• kısa kol alçı
• konservatif tedavi

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