Session IV - Upper Extremity


Fri., 10/21/05 Upper Extremity, Paper #16, 9:51 am

Distal Radius Fractures and Concomitant Ulnar Styloid Fractures

Jorge L. Orbay, MD (d-Hand Innovations);
Alejandro Badia, MD (n); Roger K. Khouri, MD (n);
Eduardo González-Hernandez, MD (n); Igor R. Indriago, MD (n);
Miami Hand Center, Miami, Florida, USA

Purpose: Despite progress in the treatment of the distal radius fracture, understanding of the concomitant ulnar styloid fracture remains unchanged. This retrospective study examines the clinical results of a cohort of distal radius fractures treated with volar fixed angle fixation and early rehabilitation but no specific treatment for the ulnar styloid fracture.

Methods: We reviewed 200 distal radius fractures treated with volar fixed angle fixation and followed for a minimum of 6 months. No specific treatment other than accurate reduction, stable radial fixation, and early forearm rotation was provided for concomitant ulnar styloid fractures. Cases with fractures of the ulna proper were removed from the study. If present, ulnar styloid fractures were classified radiographically according to size, displacement, degree of comminution, and foveal involvement. Information was obtained from the clinical, rehabilitation, and radiographic records. Functional results were measured in terms of final finger and wrist motion, forearm rotation, and grip strength.

Results: Out of 200 distal radius fractures in 194 patients, 18 (9%) presented with concomitant fractures of the ulna proper. Therefore, 182 distal radius fractures remained in the ulnar styloid study group. Of these, 59% presented with radiographic evidence of a concomitant ulnar styloid fracture and 41% did not. Of those presenting with an ulnar styloid fracture, 21% had involvement of the ulnar fovea, 39% had a large fragment, 15% a small fragment, and 25% had other classifications. Only 19% of the ulnar styloid fractures united. Of those distal radius fractures presenting without evidence of a concomitant ulnar styloid fracture, 15% subsequently developed a local calcification or other radiographic evidence of a soft-tissue injury. There was no statistically significant correlation between final functional results and the presenting or final radiographic appearance of the ulnar styloid. There were no cases of distal radial ulnar joint instability in this series.

Conclusions/Significance: With this method of treatment the incidence of ulnar styloid nonunion is high but functionally insignificant. The precise restoration of radial length provided by volar fixed angle fixation combined with early forearm rotation may decrease the need for internal fixation of large styloid fragments. The decision to fix ulnar styloid fractures should not be based on their size but rather on the presence of gross instability.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.