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Beitragstitel Necessity is the mother of invention: Case study of osteosynthesis of a distal ulna fracture using a posterolateral fibula plate
Beitragscode P14
  1. Alina Strohmaier UniversitätsSpital Zürich Vortragender
  2. Christian von der Lippe Spital Linth
  3. Kay-Bernd Lanner Kantonsspital Sankt Gallen
Präsentationsform Poster
  • A02 - Hand
Abstract Introduction:
Isolated ulnar shaft fractures are among the rarer fractures, and clear guidelines for treatment are lacking. According to the current literature, a fracture dislocation greater than 25-50% or more than 10-15° angulation of the fragments is considered an indication for surgery. Nevertheless, the individual decision seems to remain in the foreground. A high complication rate is known, non-union and mal-union are the most common problems. This case study describes the decision making and therapy of such a fracture with an unusual plate osteosynthesis.

Case Report:
A 36-year-old male patient presented to our emergency department with right distal forearm pain after a fall downstairs. Radiologically, an isolated distal ulnar fracture was diagnosed. This multifragmentary metaphyseal fracture was displaced approximately 1/3 of the shaft width. Furthermore, it was angulated five degrees and had significant malrotation. The patient, who worked in the foodservice industry, required a rapid return to work with a return to full functionality as soon as possible. Due to the dislocation and malrotation, as well as the patient's demands, we jointly decided on surgical treatment using osteosynthesis.
The near-joint fracture with a small distal fragment and the long length of the multifragmentary fracture zone proved to be a technical challenge. All known ulnar plates from various suppliers lacked the necessary size and stability or did not have enough angle locking holes in the distal plate area. Because of the anatomical similarity of the ulna and fibula, we also considered using a distal fibula plate. The Synthes® posterolateral distal fibula plate had the appropriate minimum length and the appropriate orientation of the angular stable holes. It was therefore chosen for the osteosynthesis. The operation went smoothly. After three months, the patient had hardly any complaints in everyday life, and the x-ray showed a healed fracture.

Even with a large selection of osteosynthesis materials, there may be limitations. It is worthwhile to plan every osteosyntheses well and to compare available materials thoroughly. But sometimes, it is also necessary to be creative and think outside the box.