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Interventions for treating adults with an isolated fracture of the ulnar shaft

Handoll HHG, Pearce P
Published Online: 
13 June 2012

The ulna is one of the two bones of the forearm. Isolated fractures of the shaft of the ulna, without other fractures, often result when the forearm is raised to fend off a blow. Such fractures are fairly rare, but can result in significant disability. Most people are treated in outpatients with plaster casts or arm braces. Some are treated surgically. Surgery generally involves the re-alignment and fixation of the broken ends of the bone.

Four trials, involving a total of 237 participants, were included in the review. These trials had methodological weaknesses that could have resulted in serious bias. One trial compared 'short arm' (splintage stopping below the elbow) pre-fabricated functional braces with 'long arm' (splintage includes the elbow) plaster casts. It found no clear difference between the two groups in the time taken for the fracture to heal. However, significantly more people in the brace group were satisfied with their treatment and significantly more returned to work during their treatment. One trial compared Ace Wrap elastic bandage, short arm plaster cast and long arm plaster cast. The large loss to follow-up in this trial makes any findings tentative. However, the need for replacement of the Ace wrap by other methods due to pain does indicate the potential for a serious problem with this intervention. The third trial, which compared immediate mobilisation versus short arm plaster cast versus long arm plaster cast for minimally displaced fractures, found no clear differences in outcome between these three interventions. The fourth trial found no significant differences in functional or anatomical outcomes nor complications between the two types of plates used for surgical fixation of the fracture.

Overall, there was not enough evidence from randomised controlled trials to show which methods of treatment are better for these injuries.