An Analysis of Causes and Treatment Outcome of Chronic Wrist Pain After Distal Radial Fractures

Abstract

Healed distal radial fractures are frequently complicated by chronic wrist pain which is multifactorial and can be debilitating. An accurate delineation of the pathoanatomy is the key for successful treatment. This study reviewed 22 patients who had surgical treatment between 1997 and 2001 for chronic wrist pain after distal radial fracture. Four patterns of pathoanatomy were identified: (1) ulnar impaction caused by radial malunion and shortening; (2) ulnar styloid non-union; (3) triangular fibrocartilage complex (TFCC) tears with or without distal radioulnar joint (DRUJ) instability; and (4) intercarpal ligament injuries and chondral lesions. Surgical treatment directed towards identified abnormalities gave satisfactory outcome. At six months after surgery the mean functional score improved 36%, mean pain score decreased 50%, mean grip strength improved 25%, and 64% of patients returned to work.

Surgical treatment of acute distal radioulnar joint instability associated with distal radius fractures

“…Furthermore, several authors have identified DRUJ instability as a poor prognostic factor in DRFs (Cheng et al, 2008;Geissler et al, 1996;Lindau et al, 2000b). Following on from this, Ruch et al reported that arthroscopic TFCC repair and 3 weeks of immobilization in supination in conjunction with external fixation of the DRF, resulted in no ulnar-sided wrist pain (Ruch et al, 2003).…”

Three-Dimensional Assessment of Bilateral Symmetry of the Radius and Ulna for Planning Corrective Surgeries

“…1 A malunion may cause pain, reduced motion, reduced grip strength, carpal instability, and, eventually, osteoarthritis. [2][3][4] Sometimes, a corrective osteotomy is performed to reduce the pain and improve function. The goal of the osseous correction is to restore normal relations in the distal radioulnar joint.…”

T.A.C.’ Pin Fixation for Basal Ulnar Styloid Fractures Associated With Distal Radius Fractures

“…6,[11][12][13][14][15][16][17] The general consensus is that fractures involving the tip or the waist of the ulnar styloid should be treated nonsurgically because the nonunion is usually asymptomatic, but whether basal ulnar styloid fractures should be treated surgically or not is still controversial. 6,[11][12][13][14][15][16][17] The general consensus is that fractures involving the tip or the waist of the ulnar styloid should be treated nonsurgically because the nonunion is usually asymptomatic, but whether basal ulnar styloid fractures should be treated surgically or not is still controversial.…”

“…6,[11][12][13][14][15][16][17] The general consensus is that fractures involving the tip or the waist of the ulnar styloid should be treated nonsurgically because the nonunion is usually asymptomatic, but whether basal ulnar styloid fractures should be treated surgically or not is still controversial. 10,16 Fractures at the base of the ulnar styloid with substantial displacement (defined as >2 mm) have been proposed to be risk factors for the development of DRUJ instability. [17][18][19][20] In contrast, nonunion or malunion have been reported to cause DRUJ instability due to concomitant triangular fibrocartilage complex injury.…”