- night stick fracture: mechanism: direct trauma w/ forearm used to block blow
    - stable frx:
          - diplaced < 50% = Stable;
          - periosteum & interosseous membrane are intact & act as restraint to rotation;
    - unstable fracture:
          - displaced > 50% or > 10-15 deg angulation;
          - angulation or displacement towards the interosseous membrane is poorly tolerated;      
          - periosteum and interosseous membrane disrupted;
          - associated injuries: radial head frx or dislocation (see Montegga frx)
    - non operative treatment:
          - indicated for fractures in the distal 2/3 of the forearm with less than 10-15 deg angulation and more than 50% to 75% fracture opposition;
          - well fitted forearm cast or brace which does not interfere with wrist or elbow motion;
          - expect 50% reduction of forearm pronation or supination while in the brace;
          - references:
                  - Treatment of ulnar fractures by functional bracing.
                  - The isolated fracture of the ulnar shaft. Treatment without immobilization.
                  - Bracing of stable shaft fractures of the ulna. 
                  - Early mobilization of isolated ulnar-shaft fractures.
                  - Isolated ulnar shaft fractures. Comparison of treatment by a functional brace and long-arm cast.
                  - Treatment of isolated ulnar shaft fractures with prefabricated functional fracture braces.
                  - The isolated fracture of the ulnar shaft. Treatment without immobilization.

    - surgical options:
          - see: approach to the ulna and plating techniques;
          - open fractures: (see Gustillo classification)
          - open fractures should be treated as an emergency, but fixation may be delayed upto 24 hrs;
                 - immediate ORIF in grade I, II, and IIIa fractures can have good results (low infection rate);
                 - autogenous bone grafting can be carried out early for grade I and II fractures (if needed);
                 - grade IIIb and IIIc fractures had poor results;
                         - these fractures were serially debrided until judged clean, only at which time was bone grafting performed;
                         - despite these measures, infections may occur in upto 3/4 of these patients;
                         - wound closure:
                         - some surgeons will close surgical incisions, where as, traumatic wounds are left open and are closed by delayed suture at a second or third look debridement;
                                 - 2 days of antibiotics should follow each wound debridement;
                         - consider antibiotic bead pouch between debridements;
          - references:
                 - Immediate internal fixation of open fractures of the diaphysis of the forearm.
                 - The necessity of acute bone grafting in diaphyseal forearm fractures: a retrospective review. 
                 - The treatment of isolated fractures of the distal ulna.
                 - Isolated ulnar shaft fractures. Retrospective study of 46 cases.
                 - Non-union of the isolated fracture of the ulnar shaft in adults.
                 - Early mobilization of isolated ulnar-shaft fractures.
                 - Isolated ulnar shaft fractures. Comparison of treatment by a functional brace and long-arm cast.
                 - Treatment of isolated ulnar shaft fractures with prefabricated functional fracture braces.

    - frx complications:  
          - non union: approx: 5%;
          - ulnar carpal abutment:
          - references:
                 - Non-union of the isolated fracture of the ulnar shaft in adults.
                 - Atrophic nonunions of the proximal ulna.