FIXATION OF ISOLATED ULNAR SHAFT FRACTURE - BY OPEN REDUCTION AND INTERNAL-FIXATION WITH PLATE OR PERCUTANEOUS INTRAMEDULLARY NAILING

Purpose of the study The authors report a study from a series of 113 a dults treated by osteosynthesis in a seven year period, for an adult i solated ulnar shaft fracture by osteosynthesis. These patients were di vided into two groups: 57 patients treated by open reduction and AO pl ate fixation (group n degrees 1), and 56 patients operated by percutan eous intramedullary nailing, according to Bohler technique, with a sim ple Kirschner pin suited into the medullary canal (group n degrees 2). Material and methods For this ulnar fracture, the proportion of men a nd women was equal, with an average age of 37 years, predominant on th e left limb (61 per cent). The most common cause was direct trauma (71 per cent): Bohler's ''parry fracture'', followed by traffic accidents (14 per cent), and 6 per cent by falls. We never found, in this serie s, indirect fractures by fall on the hand palm, and never clinical or radiological objective signs for a suspected lesion of the proximal an d distal joints. Both operative procedures are described, with a parti cular emphasis on the simplicity of the nailing technique. No immobili zation, of any kind, was applied, and patients were allowed to start f ull movements of the wrist and elbow, immediately after surgery. Resul ts There were no early post operative complications, but great differe nces in the evolution between both groups. In group n degrees 1, there was a 29,8 per cent complication rate, 47 per cent of this was consid ered as ''major'' including osteomyelitis, non union, plate breakage, screw loosening, refractures. Patients in group n degrees 2, suffered only a few ''minor'' complications. Functional and anatomical results were also better in group 2 with earlier return to work. Discussion Is olated fracture of the ulnar shaft in the adult is known as a problema tic fracture which needs long time to unite and often ends in non unio n. If opinion varies between plaster or internal fixation, we have aba ndoned the conservative treatement for the osteosynthesis. In order to demonstrate that intramedullary nailing technique gives a ''sufficien t'' fixation, the authors pointed out the biomechanical importance of soft tissues structure preservation. Conclusion Percutaneous intramedu llary nailing of isolated ulnar shaft fractures in adult, is a simple and inexpensive technique, which gives predictable bone union, without particular complication and without drawbacks of other internal fixat ion techniques.