Related Subjects:
|Shoulder Anterior Dislocations
|Shoulder:Posterior Dislocation
|Elbow Dislocation
|Olecranon Fracture
|Distal Humerus Fracture
|Radial Head and Neck Fractures
|Forearm Fractures
|Shaft of Ulna Fracture
|Wrist Colles Fracture
|Wrist Smith’s Fracture
🦴 Introduction
- A shaft of ulna fracture, also known as a “Night-stick” fracture, usually involves the middle third of the ulna.
- Caused by a direct blow to the forearm, classically when the patient raises their arm defensively to protect the face.
🔍 Clinical Features
- Forearm Deformity: Visible abnormality along the ulna.
- Palpable Step or Crepitus: Felt over the ulnar border.
- Pain & Tenderness: Localised along the mid-shaft of ulna.
- Neurovascular Status: Always assess and document - especially ulnar nerve function:
- Motor: Finger abduction/adduction.
- Sensory: Little finger border of the hand.
🩻 X-Ray Findings
- Request Radius & Ulna X-rays: Ensure the whole forearm is imaged.
- Check Elbow: Obtain lateral elbow X-ray to assess the radial–capitellar line.
- Rule out Monteggia Fracture: Ulna fracture with associated radial head dislocation.
🛠️ Management
- 💊 Analgesia: Provide adequate pain control.
- 🩹 Immobilisation:
- Apply a long-arm back-slab (above elbow).
- Support with a broad-arm sling for comfort.
- 📞 Orthopaedic Referral: Refer to the on-call team for assessment.
- 📅 Follow-Up: Arrange Virtual Fracture Clinic (VFC) review.
⚠️ Key Teaching Points
- Night-stick fractures are usually stable and often managed conservatively with immobilisation.
- Always exclude Monteggia fracture-dislocation - missing this can lead to chronic instability and poor function.
- Document CSM (circulation, sensation, movement) before and after splinting.