Treatment of ulnar shaft fractures: a prospective, randomized study. A prospective, randomized trial comparing the limited contact dynamic compression plate with the point contact fixator for forearm fractures. Isolated ulnar shaft fractures. Comparison of treatment by a functional brace and long-arm cast. Conservative management of minimally displaced isolated fractures of the ulnar shaft.
The treatment of isolated ulnar shaft fractures is controversial. Previous studies comparing treatment options have been largely retrospective and nonrandomized. In this study, consecutive patients were randomized into treatment groups of long arm plaster immobilization, short arm plaster immobilization, or Ace Wrap bandage, based on the order of hospital admission. Thirty-one patients were followed until radiographic or clinical union, with no significant difference in time to union between groups. Age, sex, fracture pattern, and displacement did not significantly influence time to union or final angulation. Two patients in both the long arm cast group and the short arm cast group lost significant motion at final follow up. Seventy percent of patients in the Ace Wrap group failed treatment secondary to pain and were converted to plaster immobilization. Furthermore, patients in this group demonstrated significantly greater angulation than those treated in a long arm cast. Our results demonstrate that above-elbow plaster immobilization offers no advantage over below-elbow immobilization. We recommend short arm casting for a period of 8 weeks. The most effective type of plate fixation for diaphyseal forearm fractures has not been defined. We performed a prospective, randomized trial in which the limited contact dynamic compression plate (LC-DCP) was compared with the Point Contact Fixator (PC-Fix) for the treatment of forearm fractures at one center.
                Ninety-two patients with 125 forearm fractures were recruited for the study and were randomly assigned to fracture fixation with one of the two devices. The average age of the patients was thirty-six years. The average duration of follow-up was twenty-two months. Patients were assessed periodically with use of radiographs and were assessed with regard to pain and function at time of the latest follow-up.
                Three patients (four fractures) in the PC-Fix group and five patients (five fractures) in the LC-DCP group had a delayed union, but no patient in either group had a nonunion. With the numbers available, there was no significant difference between the two groups with regard to operative time, time to union, callus formation, pain, or functional outcome. Deep infection occurred in one patient with a closed fracture in the PC-Fix group and in one patient with an open fracture in the LC-DCP group. In addition, one refracture occurred in each group. Both refractures occurred at the site of a screw track.
                Despite the differences in the concept of fracture fixation, these two implants appear to be equally effective for the treatment of diaphyseal forearm fractures. In a prospective study, we randomly allocated 39 patients with isolated fractures of the lower two-thirds of the ulnar shaft to treatment either by a prefabricated functional brace or a long-arm cast. Significantly better wrist function and a higher percentage of satisfied patients were found in the braced group. Thirteen patients returned to employment while still wearing the brace but only one was able to work in a cast. The purpose of this prospective study was to compare three different ways of conservative management of isolated fractures of the ulnar shaft: immediate mobilisation, below-elbow plaster cast and above-elbow plaster cast immobilisation. Over a 24-month period, 102 minimally displaced isolated fractures of the distal two-thirds of the ulnar shaft were treated on an outpatient basis. Thirty-two fractures were immobilised with an above-elbow plaster cast for 3 weeks and a below-elbow plaster cast for an additional 3 weeks. Thirty-six fractures were immobilised with a below-elbow plaster cast for 6 weeks. The remaining 34 fractures were managed with immediate mobilisation. Radiological healing, range of motion of the wrist, and pain were assessed. Results were good and were comparable in terms of healing, time to healing, pain and range of motion of the wrist.
There is insufficient evidence from randomised trials to determine which method of treatment is the most appropriate for isolated fractures of the ulnar shaft in adults. Well designed and reported randomised trials of current forms of conservative treatment are recommended.