Should an Ulnar Styloid Fracture Be Fixed Following Volar Plate fixation of a Distal Radius Fracture

Author(s): Kim JK, Koh Y-D, Do N-H

Source: J Bone Joint Surg 92A:1-6, 2010.

Summary:

The purpose of this study was to determine if an ulnar styloid fracture associated with a distal radius fracture would affect wrist function and distal radioulnar stability if there was stable plate fixation of the radius fracture.

The authors retrospectively identified 138 consecutive patients who met criteria for operative intervention of a distal radius fracture and who were treated with a volar locking distal radius plates. No associated procedures were performed on the 76 ulnar styloid fractures. Thirty-two patients with intra-operative laxity of the distal radioulnar joint were immobilized in 30 degrees of supination for four weeks.

There were no significant differences in post-operative range of motion, grip strength, DASH scores, or modified Mayo scores between patients with no ulnar fracture versus an ulnar styloid fracture. Similarly, there were no significant differences noted in post-operative range of motion, grip strength, DASH scores, or modified Mayo scores between patients with a minimally displaced fracture, and considerably displaced ulnar styloid fractures. The intra-operative laxity of the DRUJ did not correlate with either the level or the amount of displacement of the ulnar styloid fracture.

The authors conclude that stable fixation of a distal radius fracture, with correction of dorsal angulation and shortening, does not necessitate fixation of an associated ulnar styloid fracture. Additionally, based upon their observations, the intra-operative instability of the distal radioulnar joint can be corrected by immobilizing the post-operative patient in 4 weeks of slight supination without treating an associated ulnar styloid fracture.