The authors retrospectively reviewed 13 older patients (mean age of 74 years) with 14 ipsilateral fractures of the distal radius and ulnar head who were treated by isolated repair of the radial fracture and temporary wrist splint immobilization. At an average of 18 months postoperatively, the results were excellent in 11 cases and good in three cases, according to the modified Gartland and Werley score. All ulnar head fractures united: 5 with apex radial angulation and 1 with widening of the distal radioulnar joint. Mild arthritis of the distal radioulnar joint was detected in 5 cases, whereas there were no cases of distal radioulnar joint instability.
Intra-articular ulnar head fractures can involve the attachment point of the triangular fibrocartilage complex and are considered to be potentially unstable. Fixation of these fractures has been well described in young and middle age adults (J Hand Surg Am 2004 and 2007). However, in older patients, fixation of fragile osteoporotic fragments may be difficult. The findings from this study lend support to rigid fixation of a distal radial fracture and temporary splint immobilization of a concomitant, intra-articular ulnar head fracture in older patients. If this fails, one could always convert to a distal ulnar resection.