Concomitant Ulnar Styloid Fractures can be left untreated while treating Distal Radius Fractures with surgical fixation

Distal radial fractures (DRFs) are one of the most common fractures and are associated with concomitant ulnar styloid fractures (USFs) in up to 65% of cases.

Although surgical fixation of DRFs has become more common since the introduction of volar locking plates, there is no consensus on how to treat concomitant USFs. It is also unclear whether an associated USF affects the outcome of a DRF. When unstable DRFs are treated surgically, any associated USF is most commonly left untreated.

Stale Orstavik Clementsen et al conducted a study to evaluate the effect of a concomitant USF on outcome after surgical stabilization of a DRF. Investigation performed at Akershus University Hospital, Lorenskog, Norway.

Data from 2 randomized controlled trials on the treatment of unstable DRFs were pooled. The effect of a USF on the QuickDASH, EQ-5D, pain, and range of motion at 2 years was evaluated.

Key findings of the study:

• Two hundred and eighty-one patients were included; 177 (63%) had an associated, untreated USF.

• The mean patient age was 55 years (range, 19 to 70 years), and the majority of the patients were female (219, 78%).

• An unadjusted analysis demonstrated no significant difference in functional or patient-reported outcome measures (PROMs) at 2 years between patients with or without a concomitant USF.

• When controlling for confounding factors, the presence of a USF did not predict change in any of the PROMs from baseline to 2 years.

• A concomitant USF also did not predict change in grip strength or range of motion, except for a small effect on extension (-4.10; 95% confidence interval, -7.50 to -0.80; p = 0.02), which probably does not have clinical relevance.

The authors concluded that – “The main strengths of the study are the large sample size, the prospective design, and low loss of follow-up. We found that USFs in combination with DRFs did not affect PROMs, range of motion, or grip strength. Furthermore, nonunion of the USF did not affect clinical outcome. We recommend that concomitant USFs with stable distal radial ulnar joints be left untreated when treating a DRF with surgical fixation.”

Level of Evidence: Prognostic Level I.

Further reading:

The Effect of Ulnar Styloid Fractures on Patient-Reported Outcomes After Surgically Treated Distal Radial Fractures

Stale Orstavik Clementsen, Rune Bruhn Jakobsen et al

JBJS Open Access 2022:e22.00021.

http://dx.doi.org/10.2106/JBJS.OA.22.00021