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Interventions for isolated diaphyseal fractures of the ulna in adults
P K Pearce1, A Der Tavetain, H H Handoll
1Friarage Hospital, Northallerton Health Services NHS trust, Northallerton, North Yorkshire, UK, DL6 1JG. ppearce@nahs-tr.northy.nhs.uk
Background:
Isolated fractures of the shaft of the ulna, which are often sustained when the forearm is raised to shield against a blow, are generally treated on an out-patient basis.
Objectives:
To assess the effects of various forms of treatment for isolated fractures of the ulnar shaft in adults.
Search Strategy:
We searched the Cochrane Musculoskeletal Injuries Group trials register, MEDLINE (1976 to August 1999), EMBASE (1981 to September 1999), the Cochrane Controlled Trials Register (up to Issue 4, 1999), and bibliographies of trial reports. Date of the most recent search: August 1999.
Selection Criteria:
Randomised or quasi-randomised trials of conservative and surgical treatment of isolated fractures of the ulnar shaft in adults. Excluded were fractures of the proximal ulna and Monteggia fracture dislocations.
Data Collection And Analysis:
Independent quality assessment and data extraction were performed by all reviewers. Requests for more information were sent to trialists. Given the limited and poor quality evidence available, quantitative analysis was kept to a minimum.
Main Results:
Two small trials of conservative treatment, involving a total of 106 patients were included in this review. Both trials were of poor quality. One randomised trial compared short arm pre-fabricated functional braces with long arm plaster casts. There was no statistically significant difference in the time it took for fracture union. Patient satisfaction and return to work were better in the brace group. The other quasi-randomised trial compared Ace Wrap elastic bandage, short arm plaster cast and long arm plaster cast. The large loss to follow-up in this trial makes any data analysis tentative. However the need for replacement of the Ace wrap by other methods due to pain does indicate the potential for a serious problem with this intervention.
Reviewer'S Conclusions:
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. There is a need to establish the incidence of this injury and the outcome and associated costs of the various forms of treatment. Well designed randomised trials of current forms of conservative treatment are recommended.