Most patients with a nightstick fracture of the ulna are treated conservatively. Various techniques of immobilisation or early mobilisation have been studied. We performed a systematic review of all published randomised controlled trials and observational studies that have assessed the outcome of these fractures following above- or below-elbow immobilisation, bracing and early mobilisation. We searched multiple electronic databases, related bibliographies and other studies. We included 27 studies comprising 1629 fractures in the final analysis. The data relating to the time to radiological union and the rates of delayed union and nonunion could be pooled and analysed statistically.
We found that early mobilisation produced the shortest radiological time to union (mean 8.0 weeks) and the lowest mean rate of nonunion (0.6%). Fractures treated with above- or below-elbow immobilisation and braces had longer mean radiological times to union (9.2 weeks, 9.2 weeks and 8.7 weeks, respectively) and higher mean rates of nonunion (3.8%, 2.1% and 0.8%, respectively). There was no statistically significant difference in the rate of non- or delayed union between those treated by early mobilisation and the three forms of immobilisation (p = 0.142 to p = 1.000, respectively). All the studies had significant biases, but until a robust randomised controlled trial is undertaken the best advice for the treatment of undisplaced or partially displaced nightstick fractures appears to be early mobilisation, with a removable forearm support for comfort as required.
Cite this article: Bone Joint J 2013;95-B:952–9.
The authors would like to express their gratitude to the hospital librarian, L. Bryant, for searching the non-English literatures, and the corresponding authors of included trials for obtaining additional data which contributed to our systematic review. The project was funded by Zhejiang Provincial Natural Science Foundation of China (Y2110239), National Natural Science Foundation of China (81101345), and Zhejiang Key Program Science and Technology (2011C13033). All funding sources were independent and had no influence on the study design, the data extraction, analyses, interpretation of the data, writing of this article, or in the decision to submit the article for publication. Grants: Zhejiang Provincial Natural Science Foundation of China (Y2110239); National Natural Science Foundation of China (81101345); Zhejiang Key Program Science and Technology (2011C13033).
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by P. Baird and first-proof edited by J. Scott.
Supplementary material. Two tables, detailing i) the complications reported in the studies and ii) the methodological quality of the included studies based on the modified Critical Appraisal Skills Programme, are available with the electronic version of this article on our website www.bjj.boneandjoint.org.uk
- Received January 19, 2013.
- Accepted March 11, 2013.
- ©2013 The British Editorial Society of Bone & Joint Surgery