Sat., 10/18/08 Upper Extremity, Paper #71, 4:28 pm OTA-2008
The Effect of an Unrepaired Ulnar Styloid Base Fracture on Outcome after Operative Treatment of Distal Radius Fracture
J. Sebastiaan Souer, MD1 (a-AO Foundation; b-Stichting Micheal van Vloten Fonds,
Rotterdam Netherlands; Stichting Annafonds, Leiden, Netherlands);
David C. Ring, MD, PhD1 (a,e-Acumed, LLC, Biomet; a-Joint Active Systems, a,b-Small Bone
Innovations; a,b,e- Smith + Nephew, Wright Medical Technology, Inc.; c-Hand Innovations;
d-Illuminos, Inc., Mimedex, Inc.; e-Tornier); Stefan Matschke, MD3 (n);
Laurent J. Audige, MD1 (e-AO Foundation); Marta Marent2 (e-AO Foundation);
Jesse B. Jupiter, MD1 (a-Aircast (DJ), Biomet, Hand Innovations, Linvatec; Mitek, SBI, Synthes,
Wright Medical Technology, Inc., Zimmer; e-Amgen Co, Wyeth);
and the AO-CID Prospective ORIF Distal Radius Study Group;
1Massachusetts General Hospital, Boston, Massachusetts, USA;
2AO Clinical Investigation & Documentation, Dübendorf, Switzerland;
3BG Unfallklinik, Ludwigshaven, Germany
Background: The impact of an unrepaired ulnar styloid base fracture on recovery from internal fixation of a fracture of the distal radius is uncertain. We tested the hypothesis that there is no difference in motion or wrist function scores among patients with internally fixed fractures of the distal radius and either an untreated ulnar styloid base fracture or no ulnar fracture.
Methods: Two cohorts of 74 matched patients, one with an ulnar styloid base fracture and the other with no ulna fracture, were culled from a prospective cohort study of plate and screw fixation of the distal radius. Patients were matched for age, gender, AO fracture type, and injury mechanism. The two cohorts were analyzed for differences in motion, grip strength, pain, Gartland and Werley Score, Disabilities of the Arm, Shoulder and Hand, and Short Form-36 at 6, 12, and 24 months of follow-up. In a second analysis, 64 patients with less than 2 mm displacement of the ulnar styloid base fracture were compared to 49 patients with greater displacement. Statistical significance was adjusted for multiple testing using a Bonferroni correction, a P value of 0.05/16 = 0.003.
Results: There were no significant differences found between patients with unrepaired ulnar styloid base fractures and patients with no ulnar fracture at any moment of followup. However, a trend was observed towards less grip strength at 6 months (70.8 % vs 78.9% opposite arm; group difference 8% (95 confidence interval [CI]: –15.3, –0.6; P = 0.03) and less flexion (54° vs 59°; group difference of 6° [95CI: –11.7, –0.8; P = 0.02]) and ulnar deviation (32° vs 36°; group difference of 4° [95%CI: –7, –0.1; P = 0.05]) at 24 months after surgery in patients with an untreated ulnar styloid base fracture. There were no significant differences between patients with unrepaired ulnar styloid base fractures with displacement of 2 mm or greater and those with lesser displacement for any outcome measure.
Conclusions: Among patients with distal radius fractures treated with plate and screw fixation, an unrepaired base of ulnar styloid fracture does not appear to influence function or outcome, even when displaced.
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.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.