An Ulna fracture is a relatively common condition identified by a break in one of the long bones of the forearm, known as the ulna.
The forearm comprises of 2 long bones, known as the radius and the ulna, which are situated beside each other. The ulna bone lies on the inner part of the forearm and forms joints with the humerus (at the elbow), the radius (near the elbow and wrist) and several small carpal bones in the wrist.
During certain activities such as a fall on an outstretched arm, stress is placed on the ulna bone. When the stress is beyond what the bone can withstand, a break in the ulna may occur. This condition is known as an ulna fracture.
An Ulna fracture is common among the elderly, but can also occur in the younger patients or athletes. In most of the cases, ulna fracture occurs in combination with other injuries such as a sprained or dislocated wrist or elbow, a fractured radius, or other fractures of the hand, wrist or forearm.
Ulna Fractures can vary in location, severity, and type including avulsion fracture, stress fracture, medial epicondyle fracture, olecranon fracture, displaced fracture, un-displaced fracture, greenstick, comminuted etc.
Causes of an ulna fracture:
An ulna fracture generally occurs due to an awful weight-bearing force thrust through the wrist, forearm, or elbow which may be caused due to a fall on an outstretched hand or forearm, or a fall onto the point of the elbow.
This may occur with any fall, but is particularly common in sports such as skateboarding or snowboarding where a fall on a hard surface can prove to be dangerous. Ulna fractures can also occur due to a direct blow to the forearm from a moving object or due to collision with a stationary object.
Ulna fractures are relatively common in sports where a fall on a hard surface is easily possible. Sports games such as ice skating, cycling, running and jumping or sports involving direct physical contact such as football, soccer, rugby, basketball, and netball can be the cause of this fracture.
Signs and symptoms of an ulna fracture
Patients with an ulna fracture typically experience a sudden onset of sharp, intense wrist, forearm or elbow pain at the time of injury. This often causes the patient to cradle the affected arm so as to protect the injury.
Pain is usually felt on the front, back or little finger side of the forearm, wrist or elbow and can occasionally settle quickly leaving patients with an ache at the point of injury. This is particularly prominent at night or first thing in the morning.
Patients who are having an ulna fracture may also experience swelling, bruising and pain on firmly touching the affected region of the bone. Pain may also increase during certain movements of the wrist or elbow, when twisting the forearm, gripping or during weight-bearing activity (such as pushing) with the affected wrist.
Occasionally, a sensation of numbness may be present in the forearm, hand or fingers. In severe ulna fractures (with bony displacement), an obvious deformity may be detected.
Treatment for an ulna fracture
For those ulna fractures that involve dislocation of the wrist or elbow, treatment typically involves anatomical reduction followed by surgical internal fixation to stabilize the fracture. This may be followed by the use of a plaster cast, sling or brace for a number of weeks.
Evaluation of the fracture with follow up X-rays is important to ensure the fracture is healing in an ideal position. Once healing is confirmed and the plaster cast has been removed, rehabilitation can begin as guided by the physiotherapist treating the patient.
One of the most important components of rehabilitation following an ulna fracture is that the patient rests sufficiently from any activity that increases their pain. Activities which cause a large amount of stress through ulna should also be avoided such as lifting, weight bearing or pushing activities.
Rest from aggravating activities allows the healing process to take place in the absence of further damage. If the patient is able to perform these activities pain-free, a slow return to these types of activities is recommended, making sure there is no increase in symptoms.
Ignoring symptoms or avoiding the pain is likely to cause further damage and may slow healing or prevent healing of the ulna fracture altogether.
Patients who are having an ulna fracture should perform pain-free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. These types of exercises are particularly important, as soft tissue flexibility and strength are quickly lost with plaster cast immobilization.
Prognosis of an ulna fracture
Patients who are having a fractured ulna usually make a full recovery with appropriate management. Return to activity or sport can usually take place after a few weeks or months and should be guided by the treating physiotherapist and specialist.
In case of patients having severe injuries involving damage to other bones, soft tissue, nerves or blood vessels the recovery time may be significantly prolonged.
Physiotherapy for an ulna fracture
Physiotherapy treatment is vital in all patients with a fractured ulna to increase the rate of healing and ensure an optimal outcome. Treatment may comprise:
- soft tissue massage
- joint mobilization
- electrotherapy (e.g. ultrasound)
- taping or bracing
- exercises to improve strength and flexibility
- activity modification
Other intervention for an ulna fracture
Despite a specific physiotherapy management, some patients with this condition do not improve adequately and may require other intervention. The treating physiotherapist or doctor can advise the best course of action when this is the case.
Some patients who are initially managed conservatively may require surgery to stabilize the fracture and a bone graft to aid fracture healing.
Which are the different tests that have to be performed before treatment of Ulna Fracture?
Some of the different tests that have to be performed before treatment of fracture of Ulna:
- CT Scan
- Bone Scan