Patients with isolated, closed ulnar diaphyseal fractures may benefit from surgery
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Key takeaways:
- Patients who underwent surgical intervention had more improvements in DASH scores vs. the nonoperative group.
- Researchers found a lower adverse event rate in the surgical group.
SEATTLE — Surgical intervention for an isolated, closed ulnar diaphyseal fracture may benefit patients physiologically and radiographically, according to data presented here.
“Based on this large [randomized control trial] RCT for isolated, closed ulnar diaphyseal fractures, we believe we have provided robust data now for shared decision-making with our patients such that those treated surgically will have earlier improvement in DASH, grip strength [and] range of motion with a low adverse event rate,” Prism Schneider, MD, PhD, FRCSC, said in her presentation at the Orthopaedic Trauma Association Annual Meeting. “Those treated nonoperatively will have similar range of motion and grip strength by about 3 months, but about one-third of the patients will have an adverse event.”
Schneider and colleagues randomly assigned 99 patients aged 16 years or older with a displaced, extra-articular ulnar fracture who presented within 14 days of injury to undergo either open reduction and internal fixation with screw and plate constructs or nonoperative treatment with closed reduction and below-elbow casting. Outcomes measured included DASH score, pain VAS, grip strength, range of motion and time to union.
Schneider said patients in the surgical group had significant improvements in DASH scores at 6 weeks and in grip strength out to 12 weeks, while the nonoperative group showed improvement in grip strength out to 6 weeks.
In addition, Schneider said the two groups had no statistically significant differences in VAS pain scores. She also said the surgical group had a significantly lower adverse event rate compared with the nonoperative treatment group (7.1% vs. 32%). Radiographically, the surgical group had a higher proportion of patients healed and a lower rate of malunion than the nonoperative group, according to Schneider.
“This is the largest randomized control trial that exists for this difficult patient population,” Schneider said.
However, she added the results may be “limited because we did not have follow-up between 6 and 12 weeks, so defining the exact time to union radiographically is challenging.”
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Schneider P, et al. Paper 87. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 18-21, 2023; Seattle.
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