Outcomes Following Retrograde Intramedullary Threaded Nail Fixation of Distal Ulnar Neck Fractures.

Area of Science:

• Orthopedic surgery
• Trauma care
• Skeletal reconstruction

Background:

• Unstable distal ulnar neck fractures pose significant clinical challenges.
• Effective fixation methods are crucial for restoring wrist function and stability.
• Previous treatments have varying success rates and complication profiles.

Purpose of the Study:

• To evaluate the clinical outcomes of treating unstable distal ulnar neck fractures using a retrograde intramedullary threaded nail (IMTN).
• To assess functional recovery, radiographic union, and complication rates associated with IMTN fixation.
• To determine the long-term tolerability and hardware removal rates of IMTN in this patient cohort.

Main Methods:

• Retrospective review of 17 patients treated with retrograde IMTN for unstable distal ulnar neck fractures at a level 1 trauma center.
• Inclusion criteria required at least 1 year of post-injury follow-up.
• Data collected included demographics, fracture patterns, functional scores (VAS, PRWE), radiographic union, ulnar variance, and complications.

Main Results:

• Average time to radiographic union was 8.5 weeks with minimal change in ulnar variance (-0.55 mm).
• One case of nonunion occurred due to implant back-out; no infections or nerve injuries were reported.
• Excellent functional outcomes were observed with low average pain (0.29 VAS) and PRWE (11.8) scores, and minimal distal radioulnar joint pain.

Conclusions:

• Retrograde IMTN fixation is a viable option for unstable distal ulnar neck fractures, demonstrating high union rates and good functional outcomes.
• The low incidence of insertion-site pain and minimal hardware removal suggest good implant tolerability.
• While nonunion with implant back-out is a rare complication, IMTN fixation offers potential advantages in managing these challenging fractures.