The treatment of isolated ulnar fractures in adults: a systematic review

The treatment of isolated ulnar fractures remains controversial, with diffe rent authors recommending both surgical and nonsurgical management. We unde rtook a systematic review of the current literature in order to assess whet her any conclusions can be drawn. A total of 33 series involving 1876 patie nts were identified as suitable for analysis. Data from these papers were c ombined by method of treatment. The results of the non-operative treatment of minimally displaced ulnar fractures with a stable configuration were uni formly good. Below elbow plaster cast, functional brace and early mobilisat ion all produced similar results. An above elbow cast was unnecessarily res trictive. To preserve forearm rotation, widely displaced or unstable fractu res are best treated by open reduction and internal fixation. Guidelines ba sed on cadaveric and clinical studies exist to predict fracture stability a nd the extent of acceptable displacement. However, these have not been veri fied in clinical studies. Compression plate fixation gave reliable results in these cases. other methods lacked sufficient published data to be recomm ended, (C) 2000 Elsevier Science Ltd. All rights reserved.