Interventions for isolated diaphyseal fractures of the ulna in adults.

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 specialised register (November 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2003), MEDLINE (1966 to November week 2 2003), EMBASE (1981 to 2003 week 51) and CINAHL (1982 to December week 2 2003), Current Controlled Trials (accessed November 2003), the UK National Research Register (up to Issue 4, 2003 ), various conference proceedings and bibliographies of relevant articles. Date of the most recent search: December 2003.

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 the reviewers. Requests for more information were sent to trialists. Given the limited and generally poor quality evidence available, quantitative analysis was kept to a minimum.

MAIN RESULTS: One new trial comparing two types of plates used for the surgical fixation of these fractures was included in the fifth update of this review. Thus there are now three trials, involving a total of 135 patients. All three trials were methodologically flawed, particularly the two trials of conservative treatment. One of these 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, a 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. There were no statistically significant differences in anatomical or functional outcomes nor complications between the two plate groups in the surgical trial.

REVIEWERS' 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.