Should an Ulnar Styloid Fracture Be Fixed Following Volar Plate Fixation of a Distal Radial Fracture?

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Jae Kwang Kim, MD, PhD1, Young-Do Koh, MD, PhD1 and Nam-Hoon Do, MD1

1 Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, 911-1, Mok-6-dong, Yangcheon-gu, Seoul, 158-710, South Korea. E-mail address for J.K. Kim: kimjk@ewha.ac.kr

A commentary by Moheb S. Moneim, MD, is available at www.jbjs.org/commentary and as supplemental material to the online version of this article.

Investigation performed at the Department of Orthopedic Surgery, Ewha Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, South Korea

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.


Background Ulnar styloid fractures often occur in association with distal radial fractures. The purpose of this study was to determine whether an associated ulnar styloid fracture following stable fixation of a distal radial fracture has any effect on wrist function or on the development of chronic distal radioulnar joint instability.

Methods One hundred and thirty-eight consecutive patients who underwent surgical treatment of an unstable distal radial fracture were included in this study. During surgery, none of the accompanying ulnar styloid fractures were internally fixed. Patients were divided into nonfracture, nonbase fracture, and base fracture groups, on the basis of the location of the ulnar styloid fracture, and into nonfracture, minimally displaced (≤2 mm), and considerably displaced (>2 mm) groups, according to the amount of ulnar styloid fracture displacement at the time of injury. Postoperative evaluation included measurement of grip strength and wrist range of motion; calculation of the modified Mayo wrist score andDisabilities of the Arm, Shoulder and Hand score; as well as testing for instability of the distal radioulnar joint at a mean of nineteen months postoperatively.

Results Ulnar styloid fractures were present in seventy-six (55%) of the 138 patients. Forty-seven (62%) involved the nonbase portion of the ulnar styloid and twenty-nine (38%) involved the base of the ulnar styloid. Thirty-four (45%) were minimally displaced, and forty-two (55%) were considerably (>2 mm) displaced. We did not find a significant relationship between wrist functional outcomes and ulnar styloid fracture level or the amount of displacement. Chronic instability of the distal radioulnar joint occurred in two wrists (1.4%).

Conclusions An accompanying ulnar styloid fracture in patients with stable fixation of a distal radial fracture has no apparent adverse effect on wrist function or stability of the distal radioulnar joint.

Level of Evidence Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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