Presentation
Right periorbital ecchymosis. Tenderness of the left forearm. Reports loss of consciousness after falling from standing height. (Read case discussion)
Patient Data
Isolated midshaft ulnar fracture.
There are no signs of injuries to the distal or proximal radioulnar joints.
Case Discussion
Isolated ulnar shaft fractures, commonly referred to as nightstick fractures, are usually the result of direct trauma to the ulnar aspect of the forearm, this usually happens when someone uses their forearm to defend themselves from strikes.
In the present case, given the context of an isolated ulnar fracture with an unplausible mechanism of trauma associated with unilateral periorbital ecchymosis should raise suspicion of assault. The patent went on to have a head CT which revealed craniofacial fractures, which further suggest assault.