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Intramedullary Threaded Nail Fixation for Distal Ulna Fractures: A Case Series
Stephen M Himmelberg, MD
1, Alexander D Jeffs, M.D.
2, Nicholas C Bank, M.D.
2, Andrew Allen, MD
1, Zohair Zaidi, MD
1, J. Megan M. Patterson, MD
3; Reid W Draeger, M.D.
4(1)University of North Carolina, Chapel Hill, NC, (2)The University of North Carolina School of Medicine, Chapel Hill, NC, (3)Department of Orthopaedics, University of North Carolina, Chapel Hill, NC, (4)Department of Orthopaedics, The University of North Carolina School of Medicine, Chapel Hill, NC
Introduction:
Intramedullary threaded nail (IMTN) fixation of upper extremity fractures has gained popularity secondary to providing sufficient stability for early range of motion with minimal soft tissue disruption. Traditionally, this construct has been implemented in the fixation of metacarpal fractures. Limited in the current literature but prevalent in practice is its utilization for fixation of distal ulnar neck fractures. The aim of this study was to report radiographic and functional outcomes for patients with distal ulnar neck fractures treated with retrograde IMTN fixation at a single institution.
Methods:
At a single Level 1 Trauma Center, a retrospective review was conducted for patients with distal ulnar neck fractures treated with retrograde IMTN between 2022 and 2024. A single surgeon performed all procedures using percutaneous retrograde IMTN fixation through the central disc of the TFCC. Patients were initially immobilized post-operatively before initiating range of motion (ROM) protocol two weeks post-operatively. Post-operative radiographic images were used to calculate the ratio of IMTN diameter to the distal ulnar isthmus diameter proximal to the fracture site. Radiographic changes in displacement, angulation, and ulnar variance were calculated between initial follow-up and final follow-up radiographs. Functional outcomes including grip strength, quickDASH score, and ROM arc were collected.
Results:
7 patients with distal ulnar neck fractures were treated with percutaneous retrograde IMTN and followed for a minimum of three months. All patients were female with an average age of 65.6 years-old. All distal ulna fractures were associated with operatively treated intra-articular distal radius fractures. All patients were treated with 75 mm x 4.5 mm IMTNs. IMTN-to-Isthmus ratio was greater than 60% in all cases. Average radiographic displacement and angulation were unchanged at final follow-up except for one patient who experienced 3mm of translation. The average ulnar variance increased by 0.98 mm. Average quickDASH score at final follow-up was 15. At final follow-up, there were no post-operative complications. No patients demonstrated ulnar sided wrist pain at final follow-up and there were no instances of nonunion/revision surgery.
Discussion:
Retrograde IMTN fixation is a novel surgical technique for the treatment of distal ulnar neck fractures that can be pursued without instance of ulnar sided wrist pain. Patients treated with IMTN fixation for distal ulna fractures experience normalization of quickDASH score at final follow-up and have positive outcomes in terms of range of motion and grip strength. Post-operative radiographic outcomes demonstrate appropriate alignment with minimal displacement and no angulation following IMTN fixation
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