Ulnar Styloid Fracture in Distal Radius Fractures Managed with Volar Locking Plates: To Fix or Not?

Abstract

Distal radius fracture is usually associated with ulnar styloid fracture. Whether to fix the ulnar styloid or not remains a surgical dilemma as some surgeons believe that their repair is imperative while others feel that they should be managed conservatively. This prospective study involved 47 patients with unilateral fracture of the distal radius who met the inclusion criterion and underwent open reduction and internal fixation with volar locking plates; 28 patients (12 males and females = 16) had an associated ulnar styloid fracture (Group A) while 19 (7 males; 12 females) did not have any ulnar styloid fracture (Group B). At the time of final evaluation both the groups were compared clinically by measuring the grip strength and range of motion around the wrist and the radiologically by measuring radial angle, radial length, volar angle and ulnar variance. Subjective assessment was done using DASH score and final assessment using Demerit point system of Saito. In Group A, average time for consolidation was 9.4 weeks, 17 patients developed non-union of the ulnar styloid, average DASH scores was 4.4 and according to Demerit point system of Saito, there were 78.5 % excellent, 17.9 % good and 3.6 % fair results; there were 2 cases of loss of reduction out of which one had persistent ulnar sided wrist pain. In Group B the average time for consolidation was 10.2 weeks, average DASH score was 3.8.and Demerit point system of Saito yielded 78.9 % excellent, 15.8 % good and 5.3 % fair results. There was one case of loss of reduction and one case of carpal tunnel syndrome which was managed conservatively. Both groups attained excellent range of motion, grip strength and well maintained the post operative radiological parameters. The comparison of clinico-radiological parameters in both groups was found to be statistically insignificant. To conclude, ulnar styloid fracture or its non union does not affect the outcome of an adequately fixed distal end radius fracture. We urge caution in electing operative treatment of non-united fracture of the ulnar styloid until better scientific report for treatment of pain associated with these fracture is available.

Keywords

Distal radius fracture - Ulnar styloid fracture - Volar locking plate

• References

• 1 Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg 2001; 26A: 908-915
• 2 Szabo RM. Distal radioulnar joint instability. J Bone Joint Surg Am 2006; 14: 884-894
• 3 Zenke Y, Sakai A, Oshige T, Moritani S, Nakamura T. The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius. J Bone Joint Surg 2009; 91B: 102-107
• 4 Buijze GA, Ring D. Clinical impact of united versus nonunited fractures of the proximal half of the ulnar styloid following volar plate fixation of the distal radius. J Hand Surg 2010; 35A: 223-227
• 5 Belloti JC, Moraes VY, Albers MB et al Does an ulnar styloid fracture interfere with the results of a distal radius fracture?. J Orthop Sci 2010; 15: 216-222
• 6 Sammer DM, Shah HM, Shauver MJ, Chung KC. The effect of ulnar styloid fractures on patient-rated outcomes after volar locking plating of distal radius fractures. J Hand Surg 2009; 34A: 1595-1602
• 7 Souer JS, Ring D, Matschke S, Audige L, Marent-Huber M, Jupiter JB. Effect of an unrepaired fracture of the ulnar styloid base on outcome after plate-and-screw fixation of a distal radial fracture. J Bone Joint Surg 2009; 91A: 830-838
• 8 Kim JK, Koh YD, Do NH. Should an ulnar styloid fracture be fixed following volar plate fixation of a distal radial fracture?. J Bone Joint Surg 2010; 92A: 1-6
• 9 Rozental TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg 2006; 31 (3) 359-365
• 10 Gogna P, Selhi HS, Singla R, Mohindra M, Batra A, Mukhopadhyay R, Rohilla R, Yadav U. Osteosynthesis with long volar locked plates for metaphyseo-daiphyseal fractures ofthe distal radius. Chin J Traumatol 2013; 16 (6) 339-343
• 11 Gogna P, Selhi HS, Singla R, Devgan A, Magu NK, Mahindra P, Yamin M (2013) Dorsally comminuted fractures of the distal end of the radius: Osteosynthesis with Volar Fixed Angle Locking Plates. ISRN Orthopaedics. Article ID 131757, 6 pages
• 12 Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities ofthe arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996; 29 (6) 602-608
• 13 Saito H, Shibata M. Classification of fracture at the distal end of the radius with reference to treatment of comminuted fractures. In: Boswick JA. Current concepts in hand surgery. Lea & Febiger; Philadelphia: 1983: 129-145
• 14 Frykman G. Fracture of the distal radius including sequelae-shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand Suppl 1967; 108: 1-155
• 15 Lindau T, Arner M, Hagberg L. Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg 1997; 22: 638-643
• 16 Oskarsson GV, Aaser P, Hjall A. Do we underestimate the predictive value of the ulnar styloid affection in Colles fractures?. Arch Orthop Trauma Surg 1997; 116: 341-344
• 17 Richards RS, Bennett JD, Roth JH, Milne Jr K. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg 1997; 22A: 772-776
• 18 Tsukazaki T, Iwasaki K. Ulnar wrist pain after Colles’ fracture. 109 fractures followed for 4 years. Acta Orthop Scand 1993; 64: 462-464
• 19 Gogna P, Singla R, Gupta RK. Carpal bone fractures in distal radial fractures: is computed tomography expedient ?. Clin Orthop Surg 2014; 6: 101-102
• 20 Spence LD, Savenor A, Nwachuku I, Tilsley J, Eustace S. MRI of fractures ofthe distal radius: comparison with conventional radiographs. Skelet Radiol 1998; 27 (5) 244-249
• 21 Kazemian GH, Bakhshi H, Lilley M, Emami Tehrani Moghaddam M, Omidian MM, Safdari F, Mohammadpour I. DRUJ instability after distal radius fracture: a comparison between cases with and without ulnar styloid fracture. Int J Surg 2011; 9 (8) 648-651
• 22 Li S, Chen Y, Lin Z, Fan Q, Cui W, Feng Z. Effect of associated ulnar styloid fracture on wrist function after distal radius. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2012; 26 (6) 666-670