Comparison of surgical treatments for distal ulna fracture when combined with anterior locking plate fixation of distal radius in the over 70 age group

Abstract

We conducted a retrospective multicentre study to compare the clinical and radiographic outcomes, and complications of three surgical treatments of distal ulna fracture (DUF) when combined with anterior locking plate fixation for distal radial fracture (DRF) in patients over 70 years of age. We identified 1521 patients over 70 years of age who were diagnosed as having DRF and who underwent anterior locking plate fixation between 2015 and 2020, among which 122 cases of DUF were analysed. Three surgical treatment options for DUF were identified in this cohort: K-wire fixation (Group K), locking plate fixation (Group L) and Darrach procedure (Group D). The results of the analysis showed the total immobilization period in Group D to be the shortest among the three treatments. Functional outcomes were superior, and the rate of complications were smaller in Group D than in Group L. In addition, rotational range of motion was larger in Group D and Group L compared with Group K. In patients who are 70 years of age or older with combined unstable DRF and highly comminuted or displaced DUF, the Darrach procedure for DUF seems to be the most useful and reasonable treatment option once the fracture of the distal radius has been rigidly fixed.

Level of evidence: IV.

Keywords

Darrach procedure Kirshner wire fixation locking plate fixation distal radius fracture distal ulna fracture elderly

Get full access to this article

View all access options for this article.

References

Biyani

Simison

AJM

Klenerman

Fractures of the distal radius and ulna. J Hand Surg. 1995, 20: 357–64.

Boretto

Zaidenberg

Gallucci

Sarme

De Carli

Comparative study of internal fixation of the ulna and distal ulna resection in patients older than 70 years with distal radius and distal metaphyseal ulna fractures. Hand (NY). 2019, 14: 540–6.

Cha

Shin

Kim

Park

Treatment of unstable distal ulna fractures associated with distal radius fractures in patients 65 years and older. J Hand Surg Am. 2012, 37: 2481–7.

Glogovac

Perry

Wigton

Stern

PJ.

Treatment modality of distal ulnar head and neck fractures associated with operatively treated distal radius fractures does not affect outcomes. Hand (NY). 2022, 17: 512–8.

Kersley

Scott

BW.

Restoration of forearm rotation following malunited fractures: Baldwin's operation. J Hand Surg Br. 1990, 15: 421–4.

Kim

Koh

YD.

Management of distal ulnar fracture combined with distal radius fracture. J Hand Surg Asian Pac. 2016, 21: 155–60.

Kurozumi

Miyamoto

Suzuki

Watanabe

Does simultaneous fixation of both distal radius and distal ulnar fractures improve outcomes? A retrospective cohort study. Geriatr Orthop Surg Rehabil. 2021, 12. DOI: 10.1177/21514593211038089.

Logan

Lindau

TR.

The management of distal ulnar fractures in adults: a review of the literature and recommendations for treatment. Strategies Trauma Limb Reconstr. 2008, 3: 49–56.

Lutsky

Lucenti

Beredjiklian

PK.

Outcomes of distal ulna fractures associated with operatively treated distal radius fractures. Hand (NY). 2020, 15: 418–21.

10.

Maraşlı

Kibar

Cavit

Comparison of the functional and radiological outcomes of vascularized and non-vascularized bone graft options in the treatment of scaphoid nonunion. Jt Dis Relat Surg. 2021, 32: 736–43.

11.

Meinberg

Agel

Roberts

Karam

Kellam

JF.

Fracture and dislocation classification compendium–2018. J Orthop Trauma. 2018, 32: S1–170.

12.

Moloney

Farnebo

Adolfsson

Incidence of distal ulna fractures in a Swedish county: 74/100,000 person-years, most of them treated non-operatively. Acta Orthop. 2020, 91: 104–8.

13.

Namba

Fujiwara

Murase

Kyo

Satoh

Tsuda

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. 2009, 34: 592–7.

14.

Nicholson

Makaram

Simpson

Keating

Fracture nonunion in long bones: a literature review of risk factors and surgical management. Injury. 2021, 52: S3–11.

15.

Richards

Deal

DN.

Distal ulna fractures. J Hand Surg Am. 2014, 39: 385–91.

16.

Ring

McCarty

Campbell

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: 103–9.

17.

Ruchelsman

Raskin

Rettig

ME.

Outcome following acute primary distal ulna resection for comminuted distal ulna fractures at the time of operative fixation of unstable fractures of the distal radius. Hand (NY). 2009, 4: 391–6.

18.

Sato

Murakami

Mimata

Numata

Shiraishi

Doita

Conservative treatment of distal ulna metaphyseal fractures associated with distal radius fractures in elderly people. Orthop Traumatol Surg Res. 2018, 104: 1101–5.

19.

Yoneda

Watanabe

Primary excision of the ulnar head for fractures of the distal ulna associated with fractures of the distal radius in severe osteoporotic patients. J Hand Surg Eur. 2014, 39: 293–9.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

1.14 MB

0.41 MB

0.31 MB