Hook plate osteosynthesis allows for strong fixation in ulna head fracture associated with distal radius fracture

Distal ulna head or neck fracture is commonly associated with distal radius fracture. Treatment of these fractures remains controversial. Plate osteosynthesis is commonly performed.

Gauthier et al conducted a study to observe clinical and radiological outcomes in ulna hook plate osteosynthesis for distal ulna fracture associated with distal radius fracture.

The retrospective study included patients presenting combined displaced distal ulna fracture and distal radius fracture who were treated with ulna hook plate osteosynthesis. Patient evaluation included pain measurement with the visual analog scale, wrist range of motion, grip and pinch strengths, Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and Mayo wrist score. Preoperative radiographs were reviewed to classify the distal ulna fracture according to Biyani. Bone union was evaluated on postoperative X-rays. At final follow-up, the usual radiographic parameters were measured and distal radioulnar joint (DRUJ) osteoarthritis was assessed.

The results of the study:

• A total of 48 patients were included.

• Mean age was 63 years old and mean follow-up was 28 months.

• According to the Biyani classification, there were:

o 12 type I,

o 4 type II,

o 8 type III,

o 24 type IV distal ulna fractures.

• Wrist flexion was 60°, extension 57°, pronation 85°, and supination 80°.

• Grip strength was 21 kg (86% of the uninjured opposite side).

• Pinch strength was 6.6 kg (92% of the uninjured opposite side).

• Clinical scores were very good to excellent, with a mean Q-DASH of 12 and a Mayo wrist score of 90.

• Discomfort or pain due to the implant that required implant removal was reported in 29%, and was higher in younger patients.

• Nonunion was observed in two cases and secondary implant displacement in one case.These three cases required secondary intervention with ulna head resection, which was higher in Biyani type IV.

• DRUJ osteoarthritis was observed in 12 patients (31%) and was higher in older patients.

The authors concluded that: " In the present study, ulna hook plate fixation yielded good clinical results and a high rate of fracture union, although complications were common. We suggest plate osteosynthesis in young and active patients, which allows for strong fixation and a quick return to daily activities. However, patients should be advised that implant irritation is common and often requires implant removal. For older and less active patients, treatment remains controversial. Plate osteosynthesis gives good results with a low incidence of implant irritation, but some major complications can appear (fracture nonunion, secondary implant displacement). Ulna head resection in elderly patients remains a good alternative treatment."

Level of evidence: IV

Further reading:

Ulna hook plate osteosynthesis for ulna head fracture associated with distal radius fracture

Gauthier et al.

Journal of Orthopaedics and Traumatology (2022) 23:39

https://doi.org/10.1186/s10195-022-00658-3