Is it necessary to fix basal fractures of the ulnar styloid after anterior plate fixation of distal radius fractures? A randomized controlled trial

Abstract

The purpose of this study was to investigate the necessity for surgical fixation of basal fractures of the ulnar styloid without distal radioulnar joint (DRUJ) instability, after stabilization of associated distal radial fractures using an anterior plate. This single-centre, prospective, randomized controlled trial, conducted between 2015 to 2021, included 43 patients in each study arm who were randomized to either fixation (Group A) or non-operative treatment (Group B) of the ulnar styloid. The mean follow-up period was 24 months (SD 5.2) in Group A and 23.9 months (SD 5.5) in Group B. At the final follow-up, patients were evaluated by the Disabilities of the Shoulder, Arm, and Hand (DASH) score, the Modified Mayo Wrist Score (MMWS), the visual analogue scale (VAS) for pain, the grip strength, wrist range of motion. The DASH score was 6 (SD 2.6) in Group A and 6 (SD 2.4) in Group B; the MMWS was 87 (SD 5.6) in Group A and 87 (SD 5.6) in Group B; and the grip strength was 88% (SD 9.4) in Group A and 87% (SD 7.7) in Group B. In conclusion, fixation of basal ulnar styloid fractures is not mandatory if the DRUJ is stable after rigid fixation of the associated fracture of the distal radius.

Level of evidence: II

Keywords

Ulnar styloid distal radius fixation distal radioulnar joint randomized controlled trial

Get full access to this article

View all access options for this article.

References

Buijze

Ring

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 Am. 2010, 35: 223–7.

Cooney

Bussey

Dobyns

Linscheid

RL.

Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop. 1987, 214: 136–47.

Faierman

Jupiter

JB.

The management of acute fractures involving the distal radio-ulnar joint and distal ulna.

Hand Clin. 1998, 14: 213–29.

Geissler

Fernandez

Lamey

DM.

Distal radioulnar joint injuries associated with fractures of the distal radius. Clin Orthop Relat Res. 1996, 327: 135–46.

Hawker

Mian

Kendzerska

French

Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS) and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res. 2011, 63: 240–52.

Henry

AK.

Extensile exposure. 2nd edn. Edinburgh and London: Churchill Livingstone, 1973.

Hudak

Amadio

Bombardier

Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996, 29: 602–8.

Kim

Koh

NH.

Should an ulnar styloid fracture be fixed following volar plate fixation of a distal radial fracture?

J Bone Joint Surg Am. 2010, 92: 1–6.

Kim

Park

MJ.

Assessment of distal radioulnar joint instability after distal radius fracture: comparison of computed tomography and clinical examination results. J Hand Surg Am. 2008, 33: 1486–92.

10.

Kim

Lee

Choi

Ahn

Gong

HS.

Distal radius fracture with concomitant ulnar styloid fracture: does distal radioulnar joint stability depend on the location of the ulnar styloid fracture?

Arch Orthop Trauma Surg. 2021 Oct 7. DOI: 10.1007/s00402-021-04199-y.

11.

Lindau

Treatment of injuries to the ulnar side of the wrist occurring with distal radial fractures. Hand Clin. 2005, 21: 417–25.

12.

Lindau

Adlercreutz

Aspenberg

Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures. J Hand Surg Am. 2000, 25: 464–8.

13.

May

Lawton

Blazar

PE.

Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg Am. 2002, 27: 965–71.

14.

Nakamura

Moy

Peimer

CA.

Relationship between fracture of the ulnar styloid process and DRUJ instability: a biomechanical study.

J Wrist Surg. 2021, 10: 111–5.

15.

Oskarsson

Aaser

Hjall

Do we underestimate the predictive value of the ulnar styloid affection in Colles fractures?

Arch Orthop Trauma Surg. 1997, 116: 341–4.

16.

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: 772–6.

17.

Sammer

Chung

KC.

Management of the distal radioulnar joint and ulnar styloid fracture. Hand Clin. 2012, 28: 199–206.

18.

Sammer

Shah

Shauver

Chung

KC.

The effect of ulnar styloid fractures on patient-rated outcomes after volar locking plating of distal radius fractures. J Hand Surg Am. 2009, 34: 1595–602.

19.

Shaw

Bruno

Paul

EM.

Ulnar styloid fixation in the treatment of posttraumatic instability of the radioulnar joint: a biomechanical study with clinical correlation. J Hand Surg Am. 1990, 15: 712–20.

20.

Souer

Ring

Matschke

, et al. 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 Am. 2009, 91: 830–8.

21.

Stoffelen

De Smet

Broos

. The importance of the distal radioulnar joint in distal radial fractures. J Hand Surg Br. 1998, 23: 507–11.

22.

Szabo

RM.

Distal radioulnar joint instability.

Instructional Course Lectures. 2007, 56: 79–89.

23.

Tang

Giddins

Why and how to report surgeons’ levels of expertise. J Hand Surg Eur. 2016, 41: 365–6.

24.

Wysocki

Ruch

DS.

Ulnar styloid fracture with distal radius fracture. J Hand Surg Am. 2012, 37: 568–9.

25.

Zenke

Sakai

Oshige

Moritani

Nakamura

The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius.

J Bone Joint Surg Br. 2009, 91: 102–7.