Impact of ulnar styloid fractures in nonoperatively treated distal radius fractures

Ipsilateral fractures of the ulnar styloid with distal radius fractures; to fix or not? A systematic review and meta-analysis

Background

The most common upper limb fracture encountered in clinical practice is distal radius fracture (DRF). They frequently occur due to falls onto an outstretched hand or other traumatic incidents, resulting in a break in the radius near the wrist joint. DRFs often present a spectrum of injuries and are a common reason for emergency department visits, affecting approximately one out of every six patients seeking medical attention in this setting.

Methods

This systematic review was performed according to the guidelines of PRISMA, using the electronic database search of PubMed, Embase, Scopus, and Cochrane Library, and the protocol for the review was registered to PROSPERO. All comparative study designs (prospective or retrospective) that compared fixation of ulnar styloid and no fixation in a case of ipsilateral distal end radius fracture were included.

Results

The current review analyzed 336 patients from five studies, two randomized controlled trials (RCTs), two prospective, and one retrospective comparative study. The meta-analysis revealed a significantly higher rate of union in fixation group than the no-fixation group, with an odds ratio of 10.29 (95%CI 4.74, 22.32; p < 0.00001). However, no significant differences were found in other radiological parameters such as radial inclination, volar angle, and ulnar variance. Regarding functional outcomes, the result was equivocal for the two groups regarding DASH/quick DASH score, Modified Mayo Wrist score MD of 0.22 [95 % CI -1.84, 2.28, p = 0.83; I2 = 0 %], grip strength, range of motion, and overall complications OR of 0.53 (95 % CI 0.08, 3.47; p = 0.51; I2 = 86 %), but higher occurrence of ulnar-sided pain, hardware prominence, and paraesthesias.

Conclusion

Fixation of ulnar styloid in conjunction with DRF does not significantly benefit patients. Despite better styloid union rates, it increases implant-related complications without improving final function, range of motion, stability, or grip strength. Patients may experience increased ulnar-sided pain due to implant prominence. Therefore, non-fixation of the ulnar styloid process is recommended as it offers no significant advantages.

Conservative treatment of ulnar styloid fractures following volar-plate fixation of distal radius fractures: incidence of nonunion evaluated by computed tomography

PURPOSE

The first aim of this study was to investigate the incidence of ulnar styloid fractures (USFs) accompanied by distal radius fractures (DRFs), treated with volar locking plates. The fracture type of DRFs was evaluated by the classifications, based on computed tomography (CT) scan findings. The second aim was to investigate the bone union rate of USFs, depending on the fracture type of DRFs, by comparing union and nonunion groups in the USFs groups.

METHODS

Between May 2012 and December 2019, 239 consecutive patients with DRFs were treated. Of these patients, 177 DRFs met inclusion criteria. The fracture patterns of the DRFs, based on the classification, using CT scans, which included the AO classification, sagittal angulation, and axial fracture patterns of the articular surface of the distal radius in two-part intra-articular fractures were evaluated. The size of USFs, classified as a tip or base fracture was also investigated.

RESULTS

The incidence of USFs was significantly higher for AO types A and C than for type B. Analysis of the sagittal angulation of DRFs showed that the incidence of USFs was higher for the extension type than for the flexion type. Axial CT classification of two-part fractures revealed that DRFs with a dorsal fracture line was more frequent than the volar type of DRFs. These results suggested that dorsal displacement of DRFs was associated with a higher incidence of USFs. Finally, the analysis of the bone union rate of USFs revealed that AO classification and sagittal angulation were not correlated with bone union in USFs. However, it was found that a fracture line on the radial side of the radius had a significantly low rate of bone union, compared to a fracture line on the dorsal side. The size of USFs was also not correlated with the bone union rate.

CONCLUSIONS

The incidence and the bone union rate of USFs have different patterns. The incidence of USFs was higher in the dorsal displacement type of DRFs. However, the bone union rate of USFs was lower for a fracture line on the radial side. Therefore, USFs with DRFs that have a fracture line on the radial side is a candidate for fixation to prevent nonunion.

Prediction of Distal Radius Fracture Redisplacement: A Validation Study

OBJECTIVE

To externally validate the Edinburgh Wrist Calculator (EWC) in a population of patients with distal radius fractures at risk of loss of threshold alignment.

DESIGN

A retrospective cohort study.

SETTING

One academic hospital.

PATIENTS/PARTICIPANTS

All consecutive adult patients with a displaced distal radius fracture with initial dorsal angulation >10 degree and/or an ulnar variance of >3 mm who were treated with closed reduction and cast immobilization between 2009 and 2014.

MAIN OUTCOME MEASUREMENT

The sensitivity and specificity for diagnosis of loss of threshold alignment within 2 weeks of injury was calculated at the 10%, 40%, and the original 70% probability thresholds. The area under receiver operating characteristic curve was calculated using 2 different thresholds for loss of alignment: Mackenney et al and the Dutch consensus standards.

RESULTS

The EWC predicted a greater than 70% chance of redisplacement for only 3 fractures. Redisplacement within 2 weeks occurred in 61 of 99 (62%) fractures according to the thresholds of Mackenney et al and in 18 of 99 (18%) fractures according to the Dutch thresholds. The sensitivity increased and the specificity decreased using a lower probability threshold for redisplacement. The area under the receiver operating characteristic curve of the EWC was poor the Mackenney's thresholds [0.47; 95% confidence interval (CI): 0.36-0.59] and adequate for the Dutch thresholds (0.71; 95% CI: 0.58-0.84).

CONCLUSIONS

The EWC was a poor predictor of fracture redisplacement greater than threshold in displaced distal radius fractures in our patient population.