Intra-articular distal ulnar fractures associated with distal radial fractures in older adults: early experience in fixation of the radius and leaving the ulna unfixed

Namba, Jiro; Fujiwara, Toshihiko; Murase, Tsuyoshi; Kyo, Takayuki; Satoh, Iwao; Tsuda, Takayuki

doi:10.1177/1753193409103728

Cited by 23 publications

(26 citation statements)

References 18 publications

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“…The rate of ulnar styloid fracture in our study was 58%. Our results were consistent with previous reports that ulnar styloid fractures are usually present in 50% to 65% of the DRF [17,19,21,25,31]. The incidence of the TFCC tear complicated to the DRF was reported to vary widely from 9% to 84% [32-36].…”

Section: Discussionsupporting

confidence: 93%

Will the untreated ulnar styloid fracture influence the outcome of unstable distal radial fracture treated with external fixation when the distal radioulnar joint is stable

Chen

Zheng

et al. 2013

BMC Musculoskelet Disord

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BackgroundThe ulnar styloid is an important supportive structure for the triangular fibrocartilage complex. However, it remains inconclusive whether or not a fractured ulnar styloid should be fixed in an unstable distal radius fracture (DRF) with a stable distal radioulnar joint (DRUJ). The purpose of this study is to evaluate the effect of an untreated ulnar styloid fracture on the outcome of unstable DRF treated with transarticular external fixation when the DRUJ is stable.Methods106 patients with an unstable DRF and a stable DRUJ were included in this study following external fixation. The patients were divided into the non-fracture, the tip-fracture and the base-fracture groups according to the location of the ulnar styloid fracture at the time of injury. Postoperative evaluation included the range of wrist motion, the radiological index, the grip strength, the PRWE-HK scores, the wrist pain scores, and the instability of DRUJ at the external fixator removal time, three months postoperatively and the final follow-up visit.ResultsThe patients were followed for 12 to 24 months (15 months in average). Sixty-two of 106 patients (58%) had ulnar styloid fracture and 16 patients (26%) showed radiographic evidence of union of ulnar styloid fractures at the final follow-up visit. No significant difference in the radiological findings, the range of wrist motion, the grip strength, the PRWE-HK scores, and the wrist pain scores among three patient groups was detected at the external fixator removal time, three months postoperatively, or the final follow-up visit. Six of the 106 patients (5.7%) complained of persistent ulnar-side wrist pain during daily activities. One patient (0.9%) showed a positive sign in a stress-test, three patients (2.8%) showed a positive sign in a provocative-test, and five patients (4.7%) showed a positive sign in a press-test. There was no significant difference in the percentages of patients who complained of persistent ulnar-side wrist pain or showed a positive sign in the physical examination of the distal radioulnar joint among the three groups at the final follow-up time points.ConclusionWhen the DRUJ is stable, an untreated ulnar styloid fracture does not affect the wrist outcome of the patient with an unstable DRF treated with external fixation.

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Section: Discussionsupporting

confidence: 93%

Will the untreated ulnar styloid fracture influence the outcome of unstable distal radial fracture treated with external fixation when the distal radioulnar joint is stable

Chen

Zheng

et al. 2013

BMC Musculoskelet Disord

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“…Four small case series described unplanned surgery in 0 to 33% of patients. 1,[8][9][10] A recent review concluded that there is no consensus on operative versus nonoperative management of ulnar metaphyseal fractures. 11 One case series described one unplanned surgery of the ulnar neck after an open fracture.…”

Section: Discussionmentioning

confidence: 99%

Ulnar Neck Fractures Associated with Distal Radius Fractures

et al. 2017

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There is little published data to guide management of ulnar neck fractures associated with fractures of the distal radius. As unplanned surgery usually reflects adverse events and this injury combination is relatively uncommon, we used a large database to study the incidence of unplanned surgeries after surgical and nonsurgical treatment of distal metaphyseal ulna fractures associated with a distal radius fracture and identify factors associated with these unplanned surgeries. We identified 277 patients with an ulnar neck fracture associated with a distal radius fracture. Fifty-six (20%) ulnar neck fractures were initially treated operatively and six of them (11%) had a second, unplanned surgery. Of the 221 initially nonoperatively treated fractures, only one (0.45%) had a subsequent unplanned surgery that seemed unrelated to the fracture (ulnar nerve neurolysis). Bivariate analysis showed that younger age, open fracture, multifragmentary fractures, and initial operative treatment of the ulnar neck fracture were significantly associated with unplanned surgery. A multivariable analysis was not feasible due to the small number of unplanned surgeries. Eighty percent of ulnar neck fractures associated with a fracture of the distal radius was treated nonoperatively in our region, and subsequent surgery for problems was very uncommon. Operative treatment and fracture complexity were associated with unplanned surgery, which reflected some measure of injury severity, technical inadequacy, and inherent problems associated with surgery. Level II, prognostic study.

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“…Pour les fractures du col ou de la tête ulnaire, métaphyso-épiphysaires, plusieurs attitudes ont été décrites, de la fixation (parfois difficile en cas d'os très porotique), à la résection d'emblée. Récemment, Namba et al ont montré que l'abstention sur l'ulna associée à une synthèse du radius était suivie de bons résultats fonctionnels dans une population âgée [71]. En cas de luxation de l'articulation RUD, la lésion du complexe triangulaire est constante associée à des lésions de la membrane interosseuse à sa partie distale : la réduction et l'arthrorise temporaire sont nécessaires ; en revanche, une lésion du complexe triangulaire n'est pas synonyme d'instabilité constante.…”

Section: Le Problème De L'ulnaunclassified

Aspects anatomiques et biomécaniques des fractures du radius distal de l’adulte : revue de la littérature

Obert

Uhring

Rey

et al. 2012

Chirurgie de la Main

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Intra-articular distal ulnar fractures associated with distal radial fractures in older adults: early experience in fixation of the radius and leaving the ulna unfixed

Cited by 23 publications

References 18 publications

Will the untreated ulnar styloid fracture influence the outcome of unstable distal radial fracture treated with external fixation when the distal radioulnar joint is stable

Will the untreated ulnar styloid fracture influence the outcome of unstable distal radial fracture treated with external fixation when the distal radioulnar joint is stable

Ulnar Neck Fractures Associated with Distal Radius Fractures

Aspects anatomiques et biomécaniques des fractures du radius distal de l’adulte : revue de la littérature

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