Short-Term Outcomes of Retrograde Intramedullary Screw Fixation of Distal Ulna Fractures

Distal ulnar fractures can be challenging to manage, and noncompressive intramedullary screws may be a potential solution to this problem. The purpose of this study was to review our institutional experience with retrograde screw fixation of distal ulna fractures compared with conventional plating methods.

A retrospective cohort study was designed to compare adult patients who had undergone retrograde intramedullary screw fixation for a distal third ulna fracture in a single health system between June 2021 and February 2024 with controls who underwent conventional plate and screw fixation. Demographic, radiographic, implant, outcome and complication variables were compared between cohorts using inverse probability of treatment weighting.

Twenty-four patients who underwent intramedullary screw fixation were compared with 24 controls. All patients achieved radiographic union, with similar proportions achieving union at typical follow-up intervals between cohorts. Operative time was 43 minutes faster and time to mobilization was 11 days earlier in the screw cohort. Differences in prevalence of complications between cohorts did not achieve statistical significance (15% in screw cohort vs 36% in control cohort).

We found retrograde intramedullary screw fixation was able to achieve union in all fractures with a low complication profile and similar wrist range of motion at final follow-up compared with conventional plate and screw fixation. Intramedullary screw fixation was associated with significantly faster operative time and faster time to mobilization postoperatively.