Last updated on August 24, 2021
Above: 63 year old female presenting with a left oblique distal ulna fx with ulnar styloid component sustained after a fall.
Nightstick fractures are isolated fractures of the ulna, usually in a transverse orientation in the distal to mid-diaphysis . They typically result from a direct blow. It is a characteristic defensive fracture sustained when the patient tries to block a blow from an assailant branding a bar-like weapon (for example, from a policeman’s baton).
Stable fracture patterns are defined as those with displacement of < 50% and angulation of < 15°. Typically stable fractures are treated conservatively with immobilization – it is important to prevent pronation and supination, and so the immobilization should include the elbow at 90 degrees of flexion, and the forearm in neutral pronation/supination . Angulation or displacement towards the interosseous membrane is poorly tolerated. When surgery is indicated, plate fixation is employed with early range of motion.
Ali M, Clark DI, Tambe A. Nightstick Fractures, Outcomes of Operative and Non-Operative Treatment. Acta Medica (Hradec Kralove). 2019;62(1):19-23. doi: 10.14712/18059694.2019.41. PMID: 30931892.
Davis DD, Kane SM. Nightstick Fracture. 2021 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 32310411.
citeCai XZ, Yan SG, Giddins G. A systematic review of the non-operative treatment of nightstick fractures of the ulna. Bone Joint J. 2013 Jul;95-B(7):952-9. doi: 10.1302/0301-620X.95B7.31669. PMID: 23814249.