Physiotherapy Guide: Ulnar Fractures
Causes of Ulnar Fracture
An ulnar fracture refers to a break in the ulna, one of the two long bones in the forearm (along with the radius). The most common causes include:
Trauma: Direct impact or fall onto an outstretched hand is a primary cause.
Sports injuries (e.g., football, basketball, skiing)
Motor vehicle accidents
Falls, especially in elderly individuals or those with osteoporosis
High-energy impacts: Result from car accidents, falls from height, or other violent events.
Overuse or stress fractures: Chronic repetitive stress in athletes, such as in tennis players or weightlifters, can lead to stress fractures of the ulna.
Osteoporosis: In older adults, weakened bones may fracture even from minor trauma.
Management of Ulnar Fracture
Management typically involves a combination of non-surgical and surgical options, depending on the fracture's severity, location, and displacement.
Non-surgical treatment (for stable fractures):
Immobilisation: The fracture is usually treated with a cast or splint to restrict movement and allow healing.
Pain management: Utilising anti-inflammatory medications or analgesics.
Elevation: To reduce swelling, especially during the first 48 hours post-injury.
Ice application: Helps control swelling and pain in the initial phase.
Surgical treatment (for displaced fractures or complicated fractures):
Open reduction and internal fixation (ORIF): Surgical procedure to realign the bones and secure them with plates and screws.
Intramedullary nailing: Involves inserting a rod inside the bone to stabilise it during healing.
External fixation: In cases where internal fixation is not possible, an external device may be used to stabilise the bone.
Rehabilitation:
Physiotherapy begins after initial healing to regain strength, flexibility, and range of motion.
Physiotherapy Treatment
Physiotherapy plays a critical role in recovery post-fracture. The goals are to restore function, strength, and mobility. A typical physiotherapy treatment protocol may include:
Early Phase (Post-Casting or Surgery):
Gentle range of motion exercises: To maintain joint flexibility and prevent stiffness.
Isometric exercises: For strengthening the muscles around the wrist and elbow without putting stress on the healing bone.
Swelling control: Techniques such as elevation, compression, and gentle massage to reduce swelling.
Intermediate Phase:
Strengthening exercises: Focus on gradually increasing strength in the forearm, wrist, and elbow muscles.
Stretching: To improve flexibility and range of motion in the elbow and wrist joints.
Proprioceptive training: To improve coordination and awareness of the arm’s position.
Advanced Phase:
Functional exercises: Including exercises that mimic daily activities and sports movements.
Gradual return to functional activities: Depending on the nature of the fracture and the patient’s progress.
Pain Management: Techniques such as heat or cold packs, as well as modalities like ultrasound or TENS (Transcutaneous Electrical Nerve Stimulation), may be used for pain relief.
Prognosis
The prognosis for an ulnar fracture depends on the type and severity of the fracture, as well as the patient’s age and general health:
Simple fractures: Often heal well with proper management (casting or surgical intervention). Most people recover fully, with return to normal function in 6 to 8 weeks.
Displaced fractures: May require surgical intervention and have a slightly longer recovery period, but the prognosis is generally good with proper treatment.
Complicated fractures (e.g., involving the joint or multiple bones) can lead to more complicated healing and may have a prolonged recovery. Some individuals may experience persistent stiffness or weakness.
Osteoporotic fractures in elderly individuals may take longer to heal and could have a higher risk of non-union or malunion (improper healing).
Regular follow-ups and appropriate rehabilitation play an essential role in maximising functional recovery and reducing the risk of long-term complications.
Outcomes:
Most patients can return to normal activities within 2-3 months.
Athletes may need a longer recovery period before resuming sports, depending on the severity of the fracture and the healing process, as well as the demands of their sport.
