Ulna Fracture

InjuriesElbow & Forearm > Ulna Fracture

(Also known as an Olecranon Fracture, Fractured Ulna, Broken Ulna)

What is an ulna fracture?

An ulna fracture is a relatively common condition characterized by a break in one of the long bones of the forearm, known as the ulna (figure 1).

Ulna Fracture Anatomy

Figure 1 – Relevant Anatomy for an Ulna Fracture

The forearm comprises of 2 long bones, known as the radius and the ulna, which are situated beside each other (figure 1). The ulna bone lies on the inner aspect of the forearm and forms joints with the humerus (at the elbow), the radius (near the elbow and wrist) and several small carpal bones in the wrist (figure 1).

During certain activities such as a fall onto the outstretched hand stress is placed on the ulna bone. When this stress is traumatic and beyond what the bone can withstand a break in the ulna may occur. This condition is known as an ulna fracture.

An ulna fracture is common among the elderly (especially those who are prone to falls), but can also occur in the younger patient or athlete. Often a fracture to the ulna occurs in combination with other injuries such as a sprained or dislocated wrist or elbow, a fractured radius (Colles’ fracture), or other fractures of the hand, wrist or forearm (such as following trauma).

Ulna Fractures can vary in location, severity and type including avulsion fracture, stress fracture, medial epicondyle fracture, olecranon fracture, displaced fracture, un-displaced fracture, greenstick, comminuted etc.

Causes of an ulna fracture

An ulna fracture most commonly occurs due to a traumatic weight bearing force through the wrist, forearm, or elbow such as fall onto the outstretched hand or forearm, or a fall onto the point of the elbow. This may occur with any fall, but is particularly common in sports such as skateboarding or snowboarding (particularly in icy conditions) where a fall onto a hard surface is unforgiving. Ulna fractures may also occur due to a direct blow to the forearm from a moving object or due to collision with a stationary object (such as road / traffic accidents or contact sports). Ulna fractures are relatively common in sports whereby a fall onto a hard surface is common such as ice skating, cycling, running and jumping sports involving change of direction such as football, soccer, rugby, basketball and netball.

Signs and symptoms of an ulna fracture

Patients with an ulna fracture typically experience a sudden onset of sharp, intense wrist, forearm or elbow pain at the time of injury. This often causes the patient to cradle the affected arm so as to protect the injury. Pain is usually felt on the front, back or little finger side of the forearm, wrist or elbow and can occasionally settle quickly leaving patients with an ache at the site of injury that is particularly prominent at night or first thing in the morning. Patients with an ulna fracture may also experience swelling, bruising and pain on firmly touching the affected region of the bone. Pain may also increase during certain movements of the wrist or elbow, when twisting the forearm, gripping or during weight-bearing activity (such as pushing) through the affected wrist. Occasionally, pins and needles or numbness may be present in the forearm, hand or fingers. In severe ulna fractures (with bony displacement), an obvious deformity may be detected.

Diagnosis of an ulna fracture

A thorough subjective and objective examination from a physiotherapist or doctor is essential to assist with diagnosis of an ulna fracture. An X-ray is required to confirm diagnosis. Further investigations such as an MRI, CT scan or bone scan may be required, in some cases, to assist with diagnosis and assess the severity of injury.

Treatment for an ulna fracture

For those ulna fractures that are displaced or involve dislocation of the wrist or elbow, treatment typically involves anatomical reduction (i.e. re-alignment of the fracture by careful manipulation under anesthetic) followed by surgical internal fixation to stabilize the fracture (using plates and screws). This may be followed by the use of a plaster cast, sling or brace for a number of weeks.

For those isolated ulna fractures that are not displaced treatment typically involves plaster cast immobilization for approximately 8 weeks.

Evaluation of the fracture with follow up X-rays is important to ensure the fracture is healing in an ideal position. Once healing is confirmed and the plaster cast has been removed, rehabilitation can begin as guided by the treating physiotherapist.

One of the most important components of rehabilitation following an ulna fracture is that the patient rests sufficiently from any activity that increases their pain. Activities which place large amounts of stress through the ulna should also be avoided particularly lifting, weight bearing or pushing activities. Rest from aggravating activities allows the healing process to take place in the absence of further damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms. This should take place over a period of weeks to months with direction from the treating physiotherapist.

Ignoring symptoms or adopting a ‘no pain, no gain’ attitude is likely to cause further damage and may slow healing or prevent healing of the ulna fracture altogether.

Patients with a fractured ulna should perform pain-free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. This is particularly important, as soft tissue flexibility and strength are quickly lost with plaster cast immobilization. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they should be commenced.

Prognosis of an ulna fracture

Patients with a fractured ulna usually make a full recovery with appropriate management (whether surgical or conservative). Return to activity or sport can usually take place in weeks to months and should be guided by the treating physiotherapist and specialist. In patients with severe injuries involving damage to other bones, soft tissue, nerves or blood vessels, recovery time may be significantly prolonged.

Physiotherapy for an ulna fracture

Physiotherapy treatment is vital in all patients with a fractured ulna to hasten healing and ensure an optimal outcome. Treatment may comprise:

  • soft tissue massage
  • joint mobilization
  • electrotherapy (e.g. ultrasound)
  • taping or bracing
  • exercises to improve strength and flexibility
  • education
  • activity modification
  • a graduated return to activity plan

Other intervention for an ulna fracture

Despite appropriate physiotherapy management, some patients with this condition do not improve adequately and may require other intervention. The treating physiotherapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan, MRI or bone scan, extended periods of plaster cast immobilization or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the fractured ulna. Occasionally, patients who are initially managed conservatively may require surgery to stabilize the fracture and a bone graft to aid fracture healing.

Exercises for an ulna fracture

The following exercises are commonly prescribed to patients with a fractured ulna following confirmation that the fracture has healed, and that the orthopaedic specialist has indicated it is safe to begin mobilization. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.

Elbow Bend to Straighten

Bend and straighten your elbow as far as possible pain free (figure 2). Aim for no more than a mild to moderate stretch. Repeat 10 times provided there is no increase in symptoms.

Exercise for an Ulna Fracture - Elbow Bend to Straighten

Figure 2 – Elbow Bend to Straighten (left side)

Wrist Bends

Begin this exercise with your forearm supported by a table or bench and your wrist and fingers over the edge (figure 3). Slowly bend your wrist forwards and backwards as far as possible pain free. Aim for no more than a mild to moderate stretch. Repeat 10 times provided there is no increase in symptoms.

Exercise for an Ulna Fracture - Wrist Bends

Figure 3 – Wrist Bends (right side)

Forearm Rotations

Begin this exercise with your elbow at your side and bent to 90 degrees (figure 4). Slowly rotate your palm up and down as far as possible pain free. Aim for no more than a mild to moderate stretch. Repeat 10 times provided there is no increase in symptoms.

Exercise for an Olecranon Fracture - Forearm Rotations

Figure 4 – Forearm Rotations (right side)

Wrist Side Bends

Begin this exercise with your forearm supported by a table or bench and your wrist and fingers over the edge (figure 5). Slowly bend your wrist from side to side as far as possible pain free. Aim for no more than a mild to moderate stretch. Repeat 10 times provided there is no increase in symptoms.

Exercise for an Ulna Fracture - Wrist Side Bends

Figure 5 – Wrist Side Bends (right side)

Tennis Ball Squeeze

Begin this exercise holding a tennis ball (figure 6). Squeeze the tennis ball as hard as possible and comfortable without pain. Hold for 5 seconds and repeat 10 times.

Exercise for an Olecranon Fracture - Tennis Ball Squeeze

Figure 6 – Tennis Ball Squeeze (right hand)

 

Physiotherapy products for an ulna fracture

Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with an ulna fracture include:

  1. Slings
  2. Wrist Braces (for ulna fractures at the wrist)
  3. Ice Packs and Heat Packs
  4. Resistance Band (for strengthening exercises under physiotherapy guidance)

To purchase physiotherapy products for a fractured ulna click on one of the above links or visit the PhysioAdvisor Shop.

Other Exercises

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