Ulnar Fracture (Broken Ulna)

First aid for a suspected broken ulna

1. Support the arm in the position found, using a sling or rolled towel.
2. Remove rings, watches and bracelets before swelling increases.
3. Apply ice wrapped in a cloth for 15 to 20 minutes.
4. Do not try to straighten the arm.
5. Get medical care. Call 911 for open fractures or a cold, pale hand.

Types of ulnar fractures

Galeazzi fractures (radius shaft fracture with dislocation of the joint between the radius and ulna at the wrist) are related injuries.

Symptoms

• Pain, especially when moving the forearm, elbow or wrist
• Swelling and bruising
• Tenderness directly over the bone
• Deformity or a bump along the forearm
• Difficulty rotating the palm up or down
• Difficulty bending or straightening the elbow (olecranon fractures)
• Numbness or tingling in the little and ring fingers if the ulnar nerve is affected

Diagnosis

A doctor will examine the arm, check skin integrity, pulses, sensation and finger movement, and order X-rays of the whole forearm including the elbow and wrist. This is important because an apparently isolated ulna fracture may come with a dislocation at the elbow (Monteggia) or wrist. CT scans may be used for complex elbow fractures.

Treatment

Non-surgical treatment

Suitable for non-displaced or minimally displaced fractures, especially isolated shaft fractures and some olecranon fractures in older, less active people:

• Cast or splint, often above the elbow initially, for about 6 to 8 weeks, sometimes switching to a functional brace
• Regular X-rays to confirm the bone stays in position
• Pain relief and elevation

Surgery

Surgery is usually needed for:

• displaced or unstable fractures
• both-bone forearm fractures in adults
• Monteggia and Galeazzi injuries
• displaced olecranon fractures
• open fractures

Techniques include plates and screws, tension band wiring for olecranon fractures, and sometimes intramedullary rods. Open fractures need cleaning, antibiotics and tetanus protection.

Children

Children's forearm fractures often heal well with closed reduction and casting because their bones remodel. Monteggia injuries in children must be recognized early to avoid long-term elbow problems.

Rehabilitation

Physical therapy restores elbow, forearm and wrist motion and grip strength. Stiffness, especially loss of forearm rotation, is common if motion is delayed.

Healing time

• Bone healing: typically 6 to 12 weeks in adults, faster in children
• Return to daily activities: often 6 to 8 weeks
• Return to heavy lifting or contact sports: usually 3 to 4 months
• Hardware removal is sometimes done later if plates or wires cause irritation, especially at the elbow

Complications

• Compartment syndrome
• Nonunion or malunion
• Loss of forearm rotation or elbow motion
• Ulnar nerve irritation or injury
• Infection after open fractures or surgery
• Irritation from hardware
• Post-traumatic arthritis of the elbow or wrist

Frequently asked questions

What is an ulnar fracture?

An ulnar fracture is a break in the ulna, the forearm bone on the little-finger side that runs from the point of the elbow to the wrist. Fractures can occur at the elbow, along the shaft, or near the wrist.

What is a nightstick fracture?

A nightstick fracture is an isolated break in the shaft of the ulna, usually caused by a direct blow to the forearm when raising the arm to protect the head. It is named after injuries from police batons.

How long does a broken ulna take to heal?

Most ulna fractures heal in 6 to 12 weeks in adults and faster in children. Full strength and range of motion may take 3 to 4 months or more, especially after surgery or elbow fractures.

Does a broken ulna need surgery?

Not always. Non-displaced fractures often heal in a cast. Displaced fractures, both-bone forearm fractures in adults, olecranon fractures that are separated, and fractures with dislocations usually need surgery with plates, screws or wires.

Can you move your fingers with a broken ulna?

Usually yes, and moving the fingers is encouraged to reduce stiffness and swelling. Severe pain when moving the fingers, especially in a cast, can signal compartment syndrome and needs emergency care.