Complications following operative versus nonoperatively managed isolated distal third ulna shaft fractures: a retrospective single-institution cohort study.

PURPOSE: This study aimed to compare radiographic and clinical outcomes of operatively versus nonoperatively managed isolated distal third ulna fractures. METHODS: This is a retrospective cohort study. Operatively and nonoperatively managed isolated distal third ulna shaft fractures on forearm radiographs in adult patients with a minimum of six-week follow-up were identified at an academic level 1 trauma center over seven years from 2017 to 2024. Outcomes included rates of radiographic evidence of union, pain scores, nonunion, tendinopathies, removal of hardware, or heterotopic ossification at final follow-up. Outcomes were compared between cases managed operatively and those managed nonoperatively. RESULTS: A total of 56 isolated distal third ulna shaft fractures were identified with a mean follow-up duration of 30.5 weeks, including 12 (21.4%) managed operatively and 44 (78.6%) managed nonoperatively. The mean age was 49.0 years in the nonoperative group and 38.6 years in the operative group (p = 0.115), and the proportions of males were higher in the nonoperative group (61.4% vs. 16.7%, p = 0.006). At final follow-up, radiographic evidence of union was present in 77.3% of nonoperative cases and 91.7% of operative cases (p = 0.266). The complication rate was lower in the nonoperative group (15.9% vs. 41.7%), although the difference was not statistically significant (p = 0.054). CONCLUSIONS: Complication and radiographic union rates were similar in isolated fractures of the distal third ulnar shaft managed operatively and nonoperatively. Both nonoperative and operative management are acceptable treatment options in appropriately selected patients.