J Wrist Surg 2018; 07(01): 071-076
DOI: 10.1055/s-0037-1605382
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ulnar Neck Fractures Associated with Distal Radius Fractures

Sezai Özkan
1   Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
2   Department of Trauma Surgery, VU University Medical Center, Amsterdam, The Netherlands
,
Stefan F. Fischerauer
1   Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
3   Department of Orthopaedics and Traumatology, Medical University of Graz, Graz, Austria
,
Thomas J.M. Kootstra
1   Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Femke M.A.P. Claessen
1   Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
David Ring
4   Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
› Author Affiliations
Funding None.
Further Information

Publication History

25 May 2017

10 July 2017

Publication Date:
08 August 2017 (online)

Abstract

Background There is little published data to guide management of ulnar neck fractures associated with fractures of the distal radius.

Purpose As unplanned surgery usually reflects adverse events and this injury combination is relatively uncommon, we used a large database to study the incidence of unplanned surgeries after surgical and nonsurgical treatment of distal metaphyseal ulna fractures associated with a distal radius fracture and identify factors associated with these unplanned surgeries.

Patients and Methods We identified 277 patients with an ulnar neck fracture associated with a distal radius fracture. Fifty-six (20%) ulnar neck fractures were initially treated operatively and six of them (11%) had a second, unplanned surgery. Of the 221 initially nonoperatively treated fractures, only one (0.45%) had a subsequent unplanned surgery that seemed unrelated to the fracture (ulnar nerve neurolysis).

Results Bivariate analysis showed that younger age, open fracture, multifragmentary fractures, and initial operative treatment of the ulnar neck fracture were significantly associated with unplanned surgery. A multivariable analysis was not feasible due to the small number of unplanned surgeries.

Conclusion Eighty percent of ulnar neck fractures associated with a fracture of the distal radius was treated nonoperatively in our region, and subsequent surgery for problems was very uncommon. Operative treatment and fracture complexity were associated with unplanned surgery, which reflected some measure of injury severity, technical inadequacy, and inherent problems associated with surgery.

Level of Evidence Level II, prognostic study.

Note

The work was performed at the Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. The IRB approval number is #2009P001019/MGH.


 
  • References

  • 1 Ring D, McCarty LP, Campbell D, Jupiter JB. Condylar blade plate fixation of unstable fractures of the distal ulna associated with fracture of the distal radius. J Hand Surg Am 2004; 29 (01) 103-109
  • 2 Logan AJ, Lindau TR. The management of distal ulnar fractures in adults: a review of the literature and recommendations for treatment. Strateg Trauma Limb Reconstr 2008; 3 (02) 49-56
  • 3 Kang HJ, Shim DJ, Yong SW, Yang GH, Hahn SB, Kang ES. Operative treatment for isolated distal ulnar shaft fracture. Yonsei Med J 2002; 43 (05) 631-636
  • 4 Cook JA, Collins GS. The rise of big clinical databases. Br J Surg 2015; 102 (02) e93-e101
  • 5 Mackenney PJ, McQueen MM, Elton R. Prediction of instability in distal radial fractures. J Bone Joint Surg Am 2006; 88 (09) 1944-1951
  • 6 Kuntz M, Teunis T, Blauth J, Ring D. Time from booking until appointment and healthcare utilization in hand surgery patients with discretionary conditions. J Hand Microsurg 2015; 7 (02) 268-275
  • 7 Becker SJ, Teunis T, Blauth J, Kortlever JT, Dyer GS, Ring D. Medical services and associated costs vary widely among surgeons treating patients with hand osteoarthritis. Clin Orthop Relat Res 2015; 473 (03) 1111-1117
  • 8 Namba J, Fujiwara T, Murase T, Kyo T, Satoh I, Tsuda T. Intra-articular distal ulnar fractures associated with distal radial fractures in older adults: early experience in fixation of the radius and leaving the ulna unfixed. J Hand Surg Eur Vol 2009; 34 (05) 592-597
  • 9 Biyani A, Simison AJ, Klenerman L. Fractures of the distal radius and ulna. J Hand Surg Br 1995; 20 (03) 357-364
  • 10 Dennison DG. Open reduction and internal locked fixation of unstable distal ulna fractures with concomitant distal radius fracture. J Hand Surg Am 2007; 32 (06) 801-805
  • 11 Richards TA, Deal DN. Distal ulna fractures. J Hand Surg Am 2014; 39 (02) 385-391
  • 12 Kindsfater K, Jonassen EA. Osteomyelitis in grade II and III open tibia fractures with late debridement. J Orthop Trauma 1995; 9 (02) 121-127