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.