What is Ulnar Fracture

Ulnar fracture is a break in the ulnar bone. The ulna is a bone in the forearm, on the same side as the little finger. The forearm is the part of the arm that is between the elbow and the wrist.

It is made up of two bones: the radius and the ulna. You can feel the ulna on the outside of the wrist and at the point of the elbow.

An ulnar fracture can happen near the wrist, near the elbow, or in the middle of the forearm. In many cases of ulnar fracture, the radius is also fractured.

What are the causes?

This condition is usually caused by a direct hit or stress to the forearm. This may result from:

• An accident, such as a car or bike accident.
• Falling with the arm outstretched.

What increases the risk?

You may be more likely to fracture your ulna if you:

• Play contact sports.
• Have a condition that causes your bones to become thin and brittle (osteoporosis).

What are the signs or symptoms?

Signs and symptoms may include:

• Pain immediately after the injury.
• An abnormal bend or bump in the arm (deformity).
• Swelling.
• Bruising.
• Numbness or weakness in your hand.
• Inability to turn your hand from side to side.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms and medical history.
• A physical exam.
• An X-ray.

How is this treated?

Treatment depends on how severe your fracture is, where it is, and how the pieces of the broken bone line up with each other (alignment).

• The first step in treatment may be for you to wear a temporary splint for a few days. After the swelling goes down, you may get a cast, get a different type of splint, or have surgery.
• If your broken bone is in good alignment, you will need to wear a splint or cast for several weeks.
• If your broken bone is not aligned (is displaced), your health care provider will need to align the bone pieces. After alignment, you will need to wear a splint or cast for up to 6 weeks. To align your broken bone, your health care provider may:
  • Move the bones back into position without surgery (closed reduction).
  • Perform surgery to align the fracture and fix the bone pieces into place with metal screws, plates, or wires (open reduction and internal fixation, ORIF).
  • Perform surgery to align the fracture and fix the bone pieces into place with pins that are attached to a stabilizing bar outside your skin (external fixation).

Treatment may also include:

• Having your cast changed after 2–3 weeks.
• Physical therapy.
• Follow-up visits and X-rays to make sure you are healing.

Follow these instructions at home:

If you have a splint:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the splint if your fingers tingle, become numb, or turn cold and blue.
• Keep the splint clean and dry.

If you have a cast:

• Do not stick anything inside the cast to scratch your skin. Doing that increases your risk for infection.
• Check the skin around the cast every day. Tell your health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do not put lotion on the skin underneath the cast.
• Keep the cast clean and dry.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.
• If your splint or cast is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.

Activity

• Do not lift anything with your injured arm.
• Do not use the injured arm to support your body weight until your health care provider says that you can.
• Ask your health care provider what activities are safe for you during recovery, and ask what activities you need to avoid.

Managing pain, stiffness, and swelling

• If directed, put ice on painful areas:
  • If you have a removable splint, remove it as told by your health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag, or between your cast and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

General instructions

• Do not put pressure on any part of the cast or splint until it is fully hardened. This may take several hours.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive until your health care provider approves. You should not drive or use heavy machinery while taking prescription pain medicine.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you have:

• Pain that does not get better with medicine.
• Swelling that gets worse.
• A bad smell coming from your cast.

Get help right away if:

• You cannot move your fingers.
• You have severe pain.
• Your fingers or your hand:
  • Become numb, cold, or pale.
  • Turn a bluish color.

Summary

• An ulnar fracture is a break in the ulnar bone, which is the bone in your forearm that is on the same side as your little finger.
• You may need to wear a splint or a cast for at least several weeks. Sometimes surgery is needed.
• Keep all follow-up visits as told by your health care provider.

Ulnar Fracture Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your wrist and forearm. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Wrist flexion, active-assisted

1. Extend your __________ arm in front of you, and point your fingers downward.
2. If told by your health care provider, bend your __________ arm.
3. Gently tip the palm of your hand toward your forearm as far as you can.
4. If told by your health care provider, use your other hand to move your palm closer to your forearm. You should feel a gentle stretch on the top of your __________ forearm and wrist.
5. Hold this position for __________ seconds.
6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Wrist extension, active-assisted

1. Extend your __________ arm in front of you and turn your palm upward.
2. If told by your health care provider, bend your __________ arm.
3. Tip your palm and fingertips back so your fingers point downward. Go as far as you can without pain.
4. If told by your health care provider, use your other hand to help point your fingers down even more. You should feel a gentle stretch on the back of your __________ forearm and wrist.
5. Hold this position for __________ seconds.
6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Supination, active

1. Stand or sit with your arms at your side.
2. Bend your __________ elbow to an “L” shape (90 degrees).
3. Turn your palm upward until you feel a gentle stretch in the inside of your forearm.
4. Hold this position for __________ seconds.
5. Slowly return your palm to the starting position.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise D: Pronation, active

1. Stand or sit with your arms at your side.
2. Bend your __________ elbow to an “L” shape (90 degrees).
3. Turn your palm downward until you feel a gentle stretch in the top of your forearm.
4. Hold this position for __________ seconds.
5. Slowly return your palm to the starting position.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise E: Ulnar deviation

1. Start with your __________ arm supported at your side or on a table.
2. Move your __________ wrist and hand so your pinkie travels toward your forearm and your thumb moves away from your forearm.
3. Hold this position for __________ seconds.
4. Slowly return your wrist to the starting position.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise F: Radial deviation

1. Start with your __________ arm supported at your side or on a table.
2. Move your __________ wrist and hand so your thumb moves toward your forearm.
3. Hold this position for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this stretch __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your forearm. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise G: Wrist flexors

1. Sit with your __________ forearm supported on a table and your hand resting palm-up over the edge of the table. Your elbow should be below the level of your shoulder.
2. Hold a __________ weight in your __________ hand. Or, hold a rubber exercise band or tube in both hands, keeping your hands at the same level and hip distance apart. There should be a slight tension in the exercise band or tube.
3. Slowly curl your hand up toward your forearm.
4. Hold this position for __________ seconds.
5. Slowly lower your hand to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise H: Wrist extensors

1. Sit with your __________ forearm supported on a table and your hand resting palm-down over the edge of the table. Your elbow should be below the level of your shoulder.
2. Hold a __________ weight in your injured hand. Or, hold a rubber exercise band or tube in both hands, keeping your hands at the same level and hip distance apart. There should be a slight tension in the exercise band or tube.
3. Slowly curl the back of your hand up toward your forearm.
4. Hold this position for __________ seconds.
5. Slowly lower your hand to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.