Arch Hand Microsurg.  2019 Mar;24(1):32-39. 10.12790/ahm.2019.24.1.32.

Clinical Outcomes of Conservative Treatment for Distal Radius Fractures with or without Ulnar Styloid Fractures

• Lee JK
• Park I
• Baek E
• Han SH

• KMID: 2440609
• DOI: http://doi.org/10.12790/ahm.2019.24.1.32

Abstract

PURPOSE
Authors attempt to analyze the characteristics of combined ulnar styloid fracture (USF) and its influence on more than a year clinical outcome in patients who underwent conservative treatment for stable distal radius fracture (DRF).
METHODS
The retrospective study is a case-control study between January 2011 and December 2016. Through the exclusion process, 175 patients were included (non-USF: 106 patients with 45.4 months mean follow-up, USF: 69 patients with 48.1 months mean follow-up). All patients were treated conservatively under acceptable distal radius alignment. The USF was divided into fracture locations. The visual analogue scale (VAS), Mayo wrist score, and Quick Disabilities of the Arm, Shoulder and Hand (DASH) outcome were assessed at the final follow-up at least more than 1 year.
RESULTS
Between two groups depending on USF, there was none of radiologic outcome difference including union time, rdial height, radial tilting, and volar tilting. The mean VAS score at the final follow-up was 1.1 in both groups. The Mayo wrist score and DASH score for functional performance were 92.3 and 7.5, respectively, in patients with DRF alone, and 90.0 and 9.2, respectively, in those with combined USF, without statistical difference. The functional outcomes also did not present significant differences, depending on USF location and whether or not union.
CONCLUSION
USF does not have a serious effect on the clinical course of more than a year of conservative treatment of DRFs, and could be managed with conservative treatment regardless of fracture type and union.

Keyword

Distal radius fracture; Ulnar styloid fracture; Conservative treatment; Functional outcome

MeSH Terms

Arm
Case-Control Studies
Follow-Up Studies
Hand
Humans
Radius Fractures*
Radius*
Retrospective Studies
Shoulder
Wrist

Reference

1. Wijffels MM, Keizer J, Buijze GA, et al. Ulnar styloid process nonunion and outcome in patients with a distal radius fracture: a meta-analysis of comparative clinical trials. Injury. 2014; 45:1889–1895.

2. Nakamura T, Iwamoto T, Matsumura N, Sato K, Toyama Y. Radiographic and arthroscopic assessment of DRUJ instability due to foveal avulsion of the radioulnar ligament in distal radius fractures. J Wrist Surg. 2014; 3:12–17.

3. Gogna P, Selhi HS, Mohindra M, Singla R, Thora A, Yamin M. Ulnar styloid fracture in distal radius fractures managed with volar locking plates: to fix or not? J Hand Microsurg. 2014; 6:53–58.

4. Kim JK, Yun YH, Kim DJ, Yun GU. Comparison of united and nonunited fractures of the ulnar styloid following volar-plate fixation of distal radius fractures. Injury. 2011; 42:371–375.

5. Sammer DM, Chung KC. Management of the distal radioulnar joint and ulnar styloid fracture. Hand Clin. 2012; 28:199–206.

6. Kim JK, Kim JO, Koh YD. Management of distal ulnar fracture combined with distal radius fracture. J Hand Surg Asian Pac Vol. 2016; 21:155–160.

7. Sawada H, Shinohara T, Natsume T, Hirata H. Clinical effects of internal fixation for ulnar styloid fractures associated with distal radius fractures: a matched case-control study. J Orthop Sci. 2016; 21:745–748.

8. Turan S, Çankaya D, Yılmaz S, Karakuş D, Dündar A, Özdemir G. Effect of ulnar styloid fracture on outcomes after conservative treatment of distal radius fracture. Eklem Hastalik Cerrahisi. 2016; 27:87–93.

9. Wolfe SW. Distal radius fractures. In : Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS, editors. Green's operative hand surgery. 7th ed. Philadelphia, PA: Elsevier;2017. p. 516–587.

10. Ruch DS, McQueen MM. Distal radius and ulna fractures. In : Rockwood CA, Green DP, Bucholz RW, MacQueen M, editors. Rockwood and Green's fractures in adults. 7th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins;2010. p. 829–880.

11. Chen Y, Chen X, Li Z, Yan H, Zhou F, Gao W. Safety and efficacy of operative versus nonsurgical management of distal radius fractures in elderly patients: a systematic review and meta-analysis. J Hand Surg Am. 2016; 41:404–413.

12. af Ekenstam F, Jakobsson OP, Wadin K. Repair of the triangular ligament in Colles' fracture. No effect in a prospective randomized study. Acta Orthop Scand. 1989; 60:393–396.

13. Kim JK, Kim DJ, Yun Y. Natural history and factors associated with ulnar-sided wrist pain in distal radial fractures treated by plate fixation. J Hand Surg Eur Vol. 2016; 41:727–731.

14. Ploegmakers J, The B, Wang A, Brutty M, Ackland T. Supination and pronation strength deficits persist at 2-4 years after treatment of distal radius fractures. Hand Surg. 2015; 20:430–434.

15. Hauck RM, Skahen J 3rd, Palmer AK. Classification and treatment of ulnar styloid nonunion. J Hand Surg Am. 1996; 21:418–422.

16. May MM, Lawton JN, Blazar PE. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg Am. 2002; 27:965–971.

17. Clarke AC, Spencer RF. Ulnar nerve palsy following fractures of the distal radius: clinical and anatomical studies. J Hand Surg Br. 1991; 16:438–440.

18. Haugstvedt JR, Berger RA, Nakamura T, Neale P, Berglund L, An KN. Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint. J Hand Surg Am. 2006; 31:445–451.

19. Richards RS, Bennett JD, Roth JH, Milne K Jr. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg Am. 1997; 22:772–776.

20. Kazemian GH, Bakhshi H, Lilley M, et al. DRUJ instability after distal radius fracture: a comparison between cases with and without ulnar styloid fracture. Int J Surg. 2011; 9:648–651.

21. Lindau T, Hagberg L, Adlercreutz C, Jonsson K, Aspenberg P. Distal radioulnar instability is an independent worsening factor in distal radial fractures. Clin Orthop Relat Res. 2000; (376):229–235.

22. Geissler WB, Fernandez DL, Lamey DM. Distal radioulnar joint injuries associated with fractures of the distal radius. Clin Orthop Relat Res. 1996; (327):135–146.

23. Fernandez DL, Geissler WB. Treatment of displaced articular fractures of the radius. J Hand Surg Am. 1991; 16:375–384.

24. Mulders MAM, Fuhri Snethlage LJ, de Muinck Keizer RO, Goslings JC, Schep NWL. Functional outcomes of distal radius fractures with and without ulnar styloid fractures: a meta-analysis. J Hand Surg Eur Vol. 2018; 43:150–157.

25. Yuan C, Zhang H, Liu H, Gu J. Does concomitant ulnar styloid fracture and distal radius fracture portend poorer outcomes? A meta-analysis of comparative studies. Injury. 2017; 48:2575–2581.