الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The distal ulna is an important component in the forearm and wrist motion. Pronation-supination is a complex movement, combining the rotation of the radius around the ulna with a horizontal and axial translation. If the distal ulna fails to heal in the proper anatomical position maintaining its original length with significant residual angulation at the fracture site, and separation of the DRUJ in a transverse axis, then a more severe limitation of forearm motion.
Most fractures of the distal ulna, which are associated with fracture distal radius, are well aligned and stable once the distal radius has been realigned and secured. At that time, there is no benefit from the internal fixation of the ulnar fracture. Unstable and displaced fractures require open reduction and surgical stabilization, usually with a mini-fragment plate to avoid derangement of the load-bearing surface.
The unstable or mal-aligned fractures of the ulnar head or neck can affect distal radioulnar joint function and diminish distal forearm stability, which can contribute to the risk of associated distal radius fracture nonunion and callus encroachment of the distal radioulnar joint, leading to chronic pain and instability.
Kang, et al, classified the isolated fractures of the distal ulna into three types according to the severity of fracture and involvement of DRUJ, Type1: Simple fracture, Type 2: Comminuted fracture without DRUJ involvement and Type 3: Comminuted fracture with DRUJ involvement.
Fractures of distal ulna associated with fractures of the distal radius are classified according to a Q modifier as: Q1- Fracture of the ulnar styloid at its base, Q2- Simple fracture of the ulnar neck, Q3- Comminuted fracture of the ulnar neck,
Q4- Fracture of ulnar head, Q5- Fracture of the ulnar head and neck and Q6- Fracture of the metaphysis.
Various methods of fixation for distal ulna fractures have been described, including the use of Kirschner wires, tension banding, and plate-screw constructs.
Stable fixation of the distal ulna is usually difficult for several reasons: 1st high incidence of osteoporosis in the affected patients, 2nd proximity of the injury to articular surfaces, and 3rd lack of a proper implant to treat these injuries.
Open reduction and internal fixation of the distal ulna fracture allow early range motion. The locked plate fixation technique 1st introduced by Dennison et al for the treatment of distal ulna fractures and achieved good outcomes. However, he has some limitations: fixation and restoration of these plates is difficult if the fracture extends to the intra- articular neck or head portion, because the articular surface of the fixation area is not large enough.
Although designed for distal ulna fractures, the indications for the plate have now been extended to the treatment of distal ulna nonunion, including ulnar styloid nonunion, providing improved security in osteopenic bone.
The distal ulna hook plate is an anatomic plate contoured to fit to the distal ulna. The good outcomes achieved in this study suggest that use of the distal ulna hook plate could be an alternative treatment method for intra-articular ulna neck or head fractures, as well as basal oblique ulnar styloid fractures. All DUFs achieved good results; functional outcomes were promising, including wide wrist ROM and no DRUJ instability. An approach including fixation for DRFs and non- intervention for DUFs is a good option for elderly patients.
This study was conducted as prospective study on 20 patients presented to Orthopedic & traumatology Department, Sohag University hospital, with distal
ulna fractures, to assess the outcomes of using Distal Ulnar Plate in treatment of distal ulna fracture in adult.
The mean age of this study patients was 39.9± 9.4 years ranging from 28 years to 53 years 80% of them were males. 70% of the participants had right side fractures. The mechanism of injury was investigated among the participants. Among our participants, there were 70% had distal ulnar fracture from assault and 30% from fall from height.
The mean range of motion among the present study participants was 20.5± 5.9 and ranging from 10 to 25. In this study the mean pain score was 22± 3.5 and ranging from 15 to 25. The mean satisfaction score was 21.5± 4.7 and ranging from 10 to 25.
Among the current study patients, the mean grip strength score was 24± 3 and ranging from 15 to 25. The mean modified Mayo wrist score was 88± 16 ranging from 50 to 100. There were 60% of the participants had excellent Mayo score, 30% of the participants had good Mayo score, no one had fair Mayo score, and 10% had poor Mayo score.
In conclusion the distal ulna hook plate is an anatomic plate contoured to fit to the distal ulna. The good outcomes achieved in this study suggest that use of the distal ulna hook plate could be an alternative treatment method for intra-articular ulna neck or head fractures, as well as basal oblique ulnar styloid fractures. All DUFs achieved good results; functional outcomes were promising, including wide wrist ROM and high patient satisfaction.
The distal ulna hook plate is an anatomic plate contoured to fit to the distal ulna. The good outcomes achieved in this study suggest that use of the distal ulna hook plate could be an alternative treatment method for intra-articular ulna neck or head fractures, as well as basal oblique ulnar styloid fractures. All DUFs achieved good results; functional outcomes were promising, including wide wrist ROM and high patient satisfaction. Residual pain is not uncommon, and patients should be informed about this. Patient counselling is paramount.
Recommendation
It is recommended to assess the outcomes of using Distal Ulnar Plate in treatment of distal ulna fracture in adult among a larger study sample with evaluation of the complications and to compare between the results in patients suffering from isolated distal ulnar fracture with those with an associated distal radius fractures.