Ulnar styloid fracture in children: a retrospective study of 46 cases

Abstract

Ulnar styloid fractures are frequently ignored in the treatment of wrist fractures in children. Forty-six untreated ulnar styloid fractures (40 tip and six base fractures) associated with radial injuries (45 patients) were retrospectively analysed. At the removal of the cast, we recorded that 80% had a nonunion of the styloid fracture. Thirty-five patients were reviewed at an average of 19 months after treatment. Thirty tip fractures and five base avulsions were found. We recorded 28 patients with a good clinical result despite 21 cases of nonunion, whereas seven patients (all nonunions) had a fair result. All the fair results suffered from intermittent pain during sports and movement, radioulnar joint instability and tears of the triangular fibrocartilage complex. It can be concluded that both distal radius and ulnar styloid fractures should be taken into account in the initial treatment and pain associated with a nonunion of the ulnar styloid in a child may be due to a tear of the triangular fibrocartilage complex.

Clinical Impact of United Versus Nonunited Fractures of the Proximal Half of the Ulnar Styloid Following Volar Plate Fixation of the Distal Radius

“…Moreover, there were no differences in outcome between fractures located at the tip (distal half) and the base (proximal half) of the ulnar styloid process. The findings of our study are inconsistent with the findings in a group of 46 children reported by Abid et al 23 Although no statistical analysis was performed in their study, children with nonunion of the ulnar styloid were more often found to have worse results and more wrist pain when compared to children with union. Six patients had intermittent wrist pain in combination with radiographic evidence of an ulnar styloid nonunion, which was located in 3 cases at the base and in 3 cases at the tip, although they did not report how base and tip fractures were defined.…”

Pediatric Distal Radius and Forearm Fractures

“…In a recent, retrospective evaluation of 46 ulnar styloid fractures in children, nonunion was seen in 80% of cases following cast immobilization. 16 Although most nonunions were associated with good clinical outcomes, some patients had functionally limiting pain and distal radioulnar joint (DRUJ) instability, often with tears of the triangular fibrocartilage complex (TFCC). Fractures through the base, when associated with DRUJ instability, are best treated with open reduction and internal fixation, typically using tension band constructs.…”

Ulnar styloid process nonunion and outcome in patients with a distal radius fracture: A meta-analysis of comparative clinical trials

“…If the pain most probably is related to nonunion of the USP, resection of the ulnar styloid, with or without repair of TFCC, or open reduction and internal fixation of the styloid process has been reported to have good results [9,23,44,48]. Buijze et al questions this outcome as it is unclear if and how the patients who request surgical treatment differ from the average patient with an ulnar styloid nonunion and whether improvement after surgery is more than a placebo effect [26].…”

“…Lindau et al showed that complete TFCC tears additional to a dislocated DRF resulted in DRUJ instability in 91% of the patients resulting in worse scores on the Gartland and Werley questionnaire [43]. Furthermore, Abid et al showed higher pain scores in children with nonunion compared to children with a consolidated ulnar styloid fracture and all the patients with a fair result (17%) who were operated on suffered from TFCC lesions [23]. Hauck et al published data on pain relief after resection of an ulnar styloid nonunion in patients with and without TFCC lesions [9].…”

“…Nonunion of the USP fracture has been proposed as a potential source of ongoing ulnar-sided wrist pain and DRUJ instability [9,22,23]. Mentzel and colleagues reported a better residual function if the USP fracture unites [24].…”