Repair of the triangular ligament in Colles' fracture. No effect in a prospective randomized study

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.

Treatment options in extra-articular distal radius fractures: a systematic review and meta-analysis

PURPOSE

This systematic literature review aimed to make a detailed overview on the clinical and functional outcomes and to get insight into the possible superiority of a treatment method for extra-articular distal radius fractures.

METHODS

Embase, Medline, Cochrane Library, Web of Science, and Google Scholar were searched for studies describing treatment results. Five treatment modalities were compared: plaster cast immobilization, K-wire fixation, volar plating, external fixation, and intramedullary fixation.

RESULTS

Out of 7,054 screened studies, 109 were included in the analysis. Overall complication rate ranged from 9% after plaster cast treatment to 18.5% after K-wire fixation. For radiographic outcomes, only volar tilt in the plaster cast group was lower than in the other groups. Apart from better grip strength after volar plating, no clear functional differences were found across treatment groups.

CONCLUSION

Current literature does not provide uniform evidence to prove superiority of a particular treatment method when looking at complications, re-interventions, and long-term functional outcomes.

What's the best surgical repair technique of an ulnar styloid fracture? A biomechanical comparison of different techniques

INTRODUCTION

8-10% of all Ulnar styloid fractures (USF) accompanying distal radius fractures are addressed surgically. The surgical fixation has to counteract forces of translation and rotation acting on the distal radioulnar joint (DRUJ). The different technics used were never compared biomechanically. Our study aims to compare the effects of different techniques of USF fixation on the forearm rotation and the dorsal-palmar (DP)-translation of the DRUJ.

MATERIAL AND METHODS

9 forearm specimens were mounted on a custom testing system. Load was applied for Pronosupination and DP-translation with the forearm placed in neutral position, pronation and supination. The positional change of the DRUJ was measured using a MicroScribe. Six different, sequential conditions were tested in the same specimen: intact, USF and 4 repair techniques (2 K-wire, tension band wiring (TBW), headless compression screw, suture anchor).

RESULTS

The USF significantly increased DP-translation and pronosupination compared to the intact condition. The DP-translation in neutral was reduced significantly with all four techniques compared to the USF condition. TBW and suture anchor also showed a significant difference to the K-wire fixation. In supination only the TBW and suture anchor significantly decreased DP-Translation. The rotational stability of the DRUJ was only restored by the K-wire fixation and the TBW.

CONCLUSIONS

All four USF repair techniques partially restored translational stability; however, only K-wire fixation and TBW techniques restored rotational stability. TBW was biomechanically superior to the other techniques as it restored translational stability and rotational stability.

A Comparative Study between Conservative and Surgical Treatments of Triangular Fibrocartilage Complex Injury of the Wrist with Distal Radius Fractures

Background

Triangular fibrocartilage complex (TFCC) injury is common in distal radius fractures. The purpose of this study was to compare the conservative and surgical treatments of TFCC injury of the wrist associated with distal radius fractures.

Methods

A retrospective study was conducted on 39 patients who received treatment for TFCC injury with distal radius fractures. All patients were treated using a volar locking plate for distal radius fractures. Twenty-six patients who received conservative treatment for TFCC through long arm splinting were classified into group 1, and 13 patients who received surgical treatment for TFCC were classified into group 2. The splint was maintained for 6 weeks in both groups. For clinical evaluation, the range of motion (ROM) of the wrist joint, patient-rated wrist evaluation (PRWE) score, Disabilities of the Arm, Shoulder and Hand (DASH) score, and grip strength were measured. Distal radioulnar joint (DRUJ) stability was evaluated through a stress load test and graded between grade 0 and 3 intraoperatively after fixation and at the final follow-up.

Results

In group 1, the average DASH score was 11.1 ± 4.4, the average PRWE score was 10.2 ± 4.6, the grip strength was 89.4% relative to the unaffected side, the average ROM of the wrist joint was 65° ± 7.0° for extension, 51.5° ± 8.1° for flexion, 86° ± 5.1° for supination, and 85° ± 5.2° for pronation, and DRUJ stability at the final follow-up was grade 0 in 58.62%, grade 1 in 31.03%, grade 2 in 10.34%, and grade 3 in 0%. In group 2, the average DASH score was 13 ± 5.0, the average PRWE score was 12.4 ± 3.7, the grip strength was 87.3% relative to the unaffected side, and the average ROM of the wrist joint was 60° ± 9.8° for extension, 53.1° ± 7.0° for flexion, 85° ± 5.3° for supination, and 86.8° ± 4.5° for pronation. At the final follow-up, DRUJ stability was grade 0 in 66.67%, grade 1 in 25%, grade 2 in 8.3%, and grade 3 in 0%. The 2 groups showed no statistically significant differences in DASH score, PREW score, grip strength, ROM, and final follow-up DRUJ stability.

Conclusions

There were no statistically significant differences in the clinical outcomes between the surgical and conservative treatment groups. Therefore, when normal radiological indices are achieved after treatment of distal radius fractures, DRUJ stability can be obtained by conservative treatment.

Acute Distal Radioulnar Joint Instability: Evaluation and Treatment

This article reviews the anatomy and mechanics of pronation and supination (axial rotation) of the forearm through the distal radioulnar joint (DRUJ), and the proximal radioulnar joint (PRUJ). Injuries to the bones and/or ligaments of the forearm, wrist, or elbow can result in instability, pain, and limited rotation. Acute dislocations of the DRUJ commonly occur along with a fracture to the distal radius, radial metadiaphysis, or radial head. These injuries are all caused by high-energy trauma. Outcomes are predicated on anatomic reduction and restoration of stability to the DRUJ and PRUJ with or without ligamentous repair or reconstruction.

Effects of Ulnar Styloid Fractures on Unstable Distal Radius Fracture Outcomes: A Systematic Review of Comparative Studies

Purpose  In this literature review, functional outcomes such as Disability of Arm, Shoulder and Hand (DASH) score and the visual analog scale (VAS) of pain along with clinical outcomes such as range of movement and grip strength of treated distal radius fractures (DRF) accompanied with ulnar styloid fractures (USF) will be compared with those with isolated DRF. Materials and Methods  We analyzed articles from MEDLINE, Embase, and CINAHL that met our predetermined inclusion and exclusion criteria as per the Preferred Reporting Items for Systematic Reviews and Meta-analysis statements. This resulted in the identification of 464 articles with 18 potentially eligible studies of which 6 were included at the full-text screening stage. The primary outcomes were wrist pain, range of motion, functional outcome and satisfaction, such as VAS, and the DASH questionnaire along with radiological assessment and incidence of complications. Results  These studies involved 796 participants with DRF and 806 wrists with DRF; 444 (55%) of DRF had an associated USF. Three studies did not report any statistically significant difference in DASH scores between the DRF patients with or without USF. Two studies reported worse DASH scores in the group with associated USF. Wrist pain was reported to be statistically significantly worse in patients with associated USF in two studies. Grip strength did not exhibit a statistically significant difference in any groups in four studies. On assessing the range of motion of the wrist and forearm, only one study reported a statistically significant difference in flexion at 2 years follow-up, with less flexion in patients with USF. Conclusion  This review suggests that there is no significant correlation between a USF and the functional and clinical outcomes of DRF treatment, albeit wrist pain and less flexion were reported in some studies to be associated with USF. There is a need for more robust evidence from large randomized controlled trials to specifically look at the effects of fixation versus nonfixation of USF on DRF, or large prospective cohort studies assessing DRF with and without USF, with a minimum of 12 months follow-up. Level of Evidence  Level II-therapeutic.

Does concomitant ulnar styloid fracture and distal radius fracture portend poorer outcomes? A meta-analysis of comparative studies

PURPOSE

An ulnar styloid fracture often occur in association with a distal radial fracture. Whether an ulnar styloid fracture interfere with the results of a distal radial fracture still remains controversial. The aim of this study was to analyse the effects of an accompanying ulnar styloid fracture on clinical outcomes in patients with distal radial fractures.

METHODS

A meta-analysis of published studies comparing outcomes of distal radial fractures with an ulnar styloid fracture versus isolated distal radial fractures was performed. Outcomes of function results, radiological evaluation, and patient reported scores were analyzed.

RESULTS

Ten studies including 1403 distal radius fractures were identified fitting inclusion criteria. There was no significant difference in wrist motion, grip strength, radial height, volar angle, ulnar variance, pain score, PRWE score, or SF-36 score for distal radial fractures associated with an ulnar styloid fracture versus isolated distal radial fractures. In final follow up, patients with associated an ulnar styloid fracture had lower radial inclination and higher DASH scores. But there was no significant clinical difference. In addition, we found there was no significant difference of outcomes between union and non-union ulnar styloid fractures.

CONCLUSIONS

Based on this meta-analysis, we suggest that an associated ulnar styloid fracture does not affect the outcomes of a distal radial fracture and clinicians should be caution in electing operative treatment for patients with an ulnar styloid fracture.

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

PURPOSE

There is no consensus on the relation between ulnar styloid process nonunion and outcome in patients with distal radius fractures. The aim of this study was to analyze whether patient-reported outcome is influenced by the nonunion of the accompanying ulnar styloid fracture in distal radius fracture patients.

METHODS

A meta-analysis of published studies comparing outcomes after distal radius fractures with a united versus a non-united ulnar styloid process was performed. In addition, if provided by the authors, the raw data of these studies were pooled and analysed as one study. The outcome measures of the analyses included patient-reported outcome, functional outcome, grip-strength, pain, and distal radioulnar joint (DRUJ) instability.

RESULTS

Data from six comparative studies were included, concerning 365 patients with a distal radius fracture. One hundred and thirty-five patients with an ulnar styloid union were compared with 230 patients with a nonunion of the ulnar styloid. No significant differences were found between groups regarding any outcome measure.

CONCLUSION

Based on this meta-analysis, there is no relation between the nonunion of the ulnar styloid process and function in patients with a distal radius fracture.

Should distal radioulnar joint be fixed following volar plate fixation of distal radius fracture with unstable distal radioulnar joint?

BACKGROUND

Distal radioulnar joint (DRUJ) instability often accompanies distal radial fractures. The goal of this study was to investigate whether DRUJ should be fixed to prevent recurrent DRUJ instability in distal radius fracture patients with unstable DRUJ following open reduction and volar plate fixation of the radius.

METHODS

A retrospective chart review was performed on forty-nine consecutive patients presenting distal radius fracture who were diagnosed with distal radioulnar instability after radius fixation with volar plate. Group one consisted of 24 patients whose DRUJs were fixed in neutral for 6 weeks with 1∼2 Kirschner wires (8 cases combined with casting), whereas group two consisted of 25 patients without DRUJ fixation. All patients had radiographic evaluation of their wrist and DRUJ for stabilities and underwent functional evaluation using modified Gartland and Werley demerit scoring system (GW score).

RESULTS

All patients were followed-up for an average of 15 months (12-24 months) after surgery. No significant difference was noted between the two groups with respect to gender, age, fracture types and damage types (no noteworthy medical comorbidities in either group). At the latest follow-up, patients in both groups had comparable grip strength, wrist motion, and visual analogue scale (VAS) and GW scores. Only one patient (2.4%) demonstrated DRUJ chronic instability, but did not require any additional surgery.

CONCLUSION

The results suggest that in patients with distal radius fractures, fixation of unstable DRUJs in neutral for 6 weeks does not have an advantage over non-fixation.

LEVEL OF EVIDENCE

III.

The effect of acute distal radioulnar joint laxity on outcome after volar plate fixation of distal radius fractures

OBJECTIVES

The objective of this study was to determine whether intraoperative laxity of the distal radioulnar joint (DRUJ) is associated with adverse postoperative outcomes after volar plate fixation of a distal radius fracture (DRF) and 4 weeks of immobilization.

DESIGNS

Prospective study with clinical and radiographic assessment.

SETTING

Level 1 trauma center.

PATIENTS

One hundred consecutive patients were treated by volar locking plate fixation at our institution for an unstable DRF from April 2007 to November 2009. Of these patients, 84 patients with a minimum follow-up of 12 months were enrolled in this study.

INTERVENTION

Intraoperative DRUJ laxity was evaluated using a radioulnar stress test after fixation of DRF using volar locking plate and splint immobilization of the forearm for 1 month in patients with intraoperative DRUJ laxity. Patients were allocated to an unstable group or stable group according to the presence of intraoperative DRUJ laxity.

MAIN OUTCOME MEASUREMENTS

Our primary outcome measure was disabilities of arm, shoulder, and hand score and the secondary outcome measures were wrist motion, grip strength, modified Mayo wrist score, visual analogue scale for wrist pain, and ongoing pain in the DRUJ.

RESULTS

Nineteen of the 84 study subjects were allocated to the unstable group and 65 to the stable group. No significant differences were observed between 2 groups in wrist range of motion, grip strength, modified Mayo wrist score, disabilities of arm, shoulder, and hand score, visual analogue scale score, and ongoing pain in the DRUJ at 1 year postoperatively.

CONCLUSIONS

In our series of patients treated with volar locking plate and immobilization of the forearm for 1 month in patients with intraoperative laxity of the DRUJ, laxity did not affect impairment, pain, or disability 1 year after fracture. However, the role of postoperative immobilization of the forearm is debatable and merits additional study.

LEVEL OF EVIDENCE

Prognostic level I.

T.A.C.' pin fixation for basal ulnar styloid fractures associated with distal radius fractures

Distal radius fractures often accompany ulnar styloid fractures. As basal ulnar styloid fractures sometimes result in symptomatic nonunion causing distal radioulnar joint instability, surgical intervention should be considered as a method of treatment. However, conventional methods of internal fixation for ulnar styloid involving tension band wiring and pinning often causes irritation of hardware, and required further surgery. We performed T.A.C.' pin fixation for basal ulnar styloid fractures associated with distal radius fractures in 24 patients. X-rays showed union at an average of 6.8 weeks postoperatively in all but 1 case, which resulted in asymptomatic fibrous nonunion. Irritation from the hardware was recognized in 3 cases, but soon disappeared after recutting or removal of the pin. At the final follow-up, no symptoms involving ulnar wrist pain or distal radioulnar instability were noted. T.A.C.' pin fixation for basal ulnar styloid is a useful method and rarely requires further surgery compared with conventional methods.

Union of the ulnar styloid fracture as a function of fracture morphology on conventional radiographs

OBJECTIVE

In a retrospective radiological study, the authors aimed to detect the influence of fracture morphology on the union rate of ulnar styloid fractures associated with distal radial fractures.

MATERIALS AND METHODS

Eighty-two out of 101 ulnar styloid fractures were included in the final statistical analysis. Initially, they were grouped into six different morphological types based on a novel classification system. They were also classified as per the established Fernández and Frykman classification systems. Furthermore, the initial ulnar styloid displacement was measured in conventional anteroposterior radiographs. Union of the ulnar styloid fracture was evaluated after at least 6 months of follow-up.

RESULTS

The current investigators demonstrated that the various ulnar styloid fracture patterns have no significant predictive value for ulnar styloid union. In contrast, it could be attested, that an initial fragment dislocation of greater than 2.4 mm in the conventional AP radiographs has a significantly lower chance of successful union (p = 0.022).

CONCLUSION

Initial displacement of the ulnar styloid should be measured in each distal radial fracture with a concomitant ulnar styloid fracture. This could be useful to inform the decision regarding surgical fixation of the ulnar styloid fragment in patients with an unstable distal radioulnar joint (DRUJ) or persistent symptoms at the ulnar aspect of the wrist.

Treatment with or without internal fixation for ulnar styloid base fractures accompanied by distal radius fractures fixed with volar locking plate

The purpose of this study was to evaluate the treatment results, with and without internal fixation of ulnar styloid base fractures associated with acute distal radius fractures. A total of 48 patients were enrolled, including 20 patients treated by internal fixation (fixation group) and 28 treated without internal fixation (non-fixation group). The evaluated parameters were postoperative range of motion, grip strength, DASH score, and the presence or absence of ulnar wrist pain over time. The outcome was assessed as "excellent" in 15 patients of the fixation group and 21 patients of the non-fixation group, and "good" in five patients of the fixation group and seven patients of the non-fixation group. There were no significant differences in the clinical outcomes or any of the parameters at the final evaluation between the two groups. However, the grip strength was significantly better in the non-fixation group than in the fixation group until 12 weeks postoperatively. The overall clinical outcome was good in both groups, with no significant difference between the groups.

[Unrepaired fracture of the styloid process of the ulna: not a bad treatment result at distal radius fracture]

BACKGROUND

There are well-defined criteria for the treatment of distal radius fractures but the impact of an unrepaired fracture of the styloid process of the ulnar on recovery after operative treatment is uncertain. This study evaluated radiological and functional results after different operative treatment procedures of distal radius fractures in patients with an untreated fracture of the styloid process of the ulna and those without such a fracture.

METHODS

Out of 480 patients with operatively treated distal radius fractures 238 were examined at least 1 year after injury. The fracture of the styloid process of the ulna was not repaired. Three groups (patients without a fracture of the styloid process of the ulna, patients with a tip fracture and those with a basal fracture) were evaluated by multivariate analysis (MANOVA) in order to detect influences of the fracture of the styloid process of the ulna on the radiological and functional results.

RESULTS

Neither the existence nor the location of the fracture of the styloid process of the ulna had a significant effect on the radiological and functional results (p(function)=0,849, p(radiology)=0,330, p(scores)=0,426, MANOVA).

CONCLUSIONS

The repair of a fracture of the styloid process of the ulna is not necessary if reduction and fixation of the distal radius fracture is anatomical and stable.

Comparison of united and nonunited fractures of the ulnar styloid following volar-plate fixation of distal radius fractures

INTRODUCTION

The purpose of this study was to determine whether associated nonunion of ulnar styloid fracture following plate-and-screw fixation of a distal radius fracture (DRF) has any effect on wrist functional outcomes, ulnar-sided wrist pain or distal radioulnar joint (DRUJ) instability.

MATERIALS AND METHODS

A total of 91 consecutive patients with a DRF and an accompanying ulnar styloid fracture treated by open reduction and volar locking plate fixation were included in this study. In the first part of the analysis, the 91 study subjects were subdivided according to the presence or not of ulnar styloid union (20 and 71, respectively) by radiography at final follow-up (average 23 months). These two cohorts were compared with respect to wrist functions at 3 months postoperatively and the final follow-up visit, and ulnar-sided wrist pain and DRUJ instability at the final follow-up visit and ulnar styloid length as determined radiographically at final follow-up. In the second part of the analysis, 49 of the 91 study subjects with an ulnar styloid base fracture were subdivided according to the presence or not of ulnar styloid base fracture union (12 and 37, respectively) at final follow-up by radiography. These two groups were also compared with respect to the above-mentioned parameters.

RESULTS

Ulnar styloid fractures united in 20 (22%) of the 91 patients at final follow-up visit (average 23 months). No significant differences were found at any time during follow-up between patients who achieved or did not achieve ulnar styloid fracture union or ulnar styloid base fracture union.

CONCLUSION

Ulnar styloid nonunion does not appear to affect wrist functional outcomes, ulnar-sided wrist pain or DRUJ stability, at least when a DRF is treated by open reduction and volar plate fixation.

The Influence of Non-union of the Ulnar Styloid on Pain, Wrist Function and Instability after Distal Radius Fracture

The influence of non-union on the outcome of distal radius fractures is debated. We tested the null hypothesis that there is no difference in pain, wrist function, or instability between patients with union or non-union of an ulnar styloid base fracture after operative treatment of a fracture of the distal radius. Eighteen adults with an ulnar styloid base non-union were compared to 16 patients with union of an ulnar styloid base fracture with a mean post-operative follow-up of 30 months. None of the patients had distal radioulnar joint instability, there were no significant differences in pain, complications, or function, and patients with nonunion had significantly greater grip strength. Ulnar styloid nonunion is not associated with pain, instability, or diminished function after fracture of the distal radius.

Acute dislocations of the distal radioulnar joint and distal ulna fractures

This article reviews acute dislocations of the distal radioulnar joint (DRUJ) and distal ulna fractures. Acute dislocations can occur in isolation or in association with a fracture to the distal radius, radial metadiaphysis (Galeazzi fracture), or radial head (Essex-Lopresti injury). Distal ulna fractures may occur in isolation or in combination with a distal radius fracture. Both injury patterns are associated with high energy. Outcomes are predicated on anatomic reduction and restoration of the stability of the DRUJ.

Triangular fibrocartilage complex tears associated with symptomatic ulnar styloid nonunions

PURPOSE

Tear of the triangular fibrocartilage complex (TFCC) and nonunion of the ulnar styloid are common lesions resulting from upper extremity injuries such as distal radius fractures. Whereas ulnar styloid fractures are a common feature of the distal radius fracture pattern, symptomatic nonunions of the ulnar styloid are found in a minority of these injuries. The purposes of this study were to confirm the association of symptomatic ulnar styloid nonunions and TFCC tears, and to report intra-articular findings and clinical outcomes for the concurrent arthroscopic management of TFCC tears and open excision of ulnar styloid nonunions in a consecutive series of patients.

METHODS

We retrospectively reviewed the medical records of 8 consecutive patients who underwent open excision of an ipsilateral ulnar styloid nonunion fragment and concurrent diagnostic arthroscopy. The diagnosis of TFCC tear was made by magnetic resonance imaging preoperatively in only 5 of 8 patients. We assessed outcomes with the Disabilities of the Arm, Shoulder, and Hand questionnaire and the visual analog scale.

RESULTS

Arthroscopic findings demonstrated full-thickness chondral injury on the dorsum of the triquetrum with a tear of the dorsal radiolunotriquetral ligament and avulsion of the ulnar margin of the TFCC from the extensor carpi ulnaris subsheath. The clinical outcome scores showed statistically significant improvement (p<.05) from the preoperative baseline, with a mean Disabilities of the Arm, Shoulder, and Hand score of 3.69 (SD, 9.68) and a mean visual analog scale pain score of 1.0 (SD, 0.83) postoperatively.

CONCLUSIONS

Symptomatic ulnar styloid nonunions can be associated with TFCC tears, and diagnostic arthroscopy should be considered in all patients who are candidates for open excision of an ulnar styloid nonunion. Concurrent arthroscopic TFCC repair and open excision of the ulnar styloid fragment is an effective surgical approach for this combined injury pattern.

Does an ulnar styloid fracture interfere with the results of a distal radius fracture?

BACKGROUND

The ulnar styloid is a supportive structure for the capsular ligament complex of the distal radioulnar joint. The relation between fractures of the ulna and distal radius is not clear, especially in regard to whether ulnar fractures predict worse outcomes for distal radius fractures. The objective of this study was to analyze the influence of ulnar styloid fractures in patients with reducible and unstable distal radius fractures.

METHODS

A total of 100 patients with unstable and reducible distal radius fractures, with or without an ulnar styloid fracture, were randomly assigned to treatment with transarticular bridging external fixation or transulnar percutaneous pinning. Follow-up was obtained for 91 patients. For the secondary data analysis, three patient cohorts were created: a no ulnar styloid fracture group with the radius fracture treated by pinning or external fixation (n = 30); an ulnar styloid fracture with radius fracture group treated by external fixation (n = 31); and an ulnar styloid fracture with radius fracture treated by pinning (n = 30). Functional and radiological outcomes were measured at 6 and 24 months. Functional outcome measures included wrist pain (visual analogue scale) and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.

RESULTS

At 24 months, patients with both fractures had worse wrist pain and worse scores on the DASH questionnaire than the patients with an isolated distal radius fracture; and those treated by pinning had less wrist pain and showed better scores on the DASH questionnaire than the patients treated by fixation.

CONCLUSIONS

Ulnar styloid fracture may be a predictive factor of worse functional outcome for distal radius fracture. Pinning and above-the-elbow casting, used to treat ulnar styloid fractures, led to better function than fixation.

Treatment of distal radius fractures

The clinical practice guideline is based on a systematic review of published studies on the treatment of distal radius fractures in adults. None of the 29 recommendations made by the work group was graded as strong; most are graded as inconclusive or consensus; seven are graded as weak. The remaining five moderate-strength recommendations include surgical fixation, rather than cast fixation, for fractures with postreduction radial shortening >3 mm, dorsal tilt >10 degrees , or intra-articular displacement or step-off >2 mm; use of rigid immobilization rather than removable splints for nonsurgical treatment; making a postreduction true lateral radiograph of the carpus to assess dorsal radial ulnar joint alignment; beginning early wrist motion following stable fixation; and recommending adjuvant treatment with vitamin C to prevent disproportionate pain.

Clinical impact of United versus nonunited fractures of the proximal half of the ulnar styloid following volar plate fixation of the distal radius

PURPOSE

Distal radius fractures are often associated with a fracture of the ulnar styloid at its base. This study tested the null hypothesis that there is no difference in outcome between patients with union and nonunion of a fracture of the proximal half of the ulnar styloid 6 months after volar plate fixation of a fracture of the distal radius.

METHODS

A total of 36 consecutive patients with fractures of both distal radius and the proximal half of the ulnar styloid enrolled in 1 of 2 clinical trials evaluating volar plate fixation of the distal radius had no treatment of the ulnar styloid fracture. Six months after surgery, wrist function was assessed using the Mayo wrist score and the Gartland and Werley score system, and arm-specific health status was measured using the Disabilities of the Arm, Shoulder, and Hand questionnaire. Pain was assessed on a 10-point ordinal scale. Nonunion of the fracture of the proximal half of the ulnar styloid was defined as no signs of consolidation on 6-month postoperative radiographs. At the 6-month follow-up, patients were assessed for overall wrist function but not specifically for ulnar-sided wrist problems or stability.

RESULTS

Sixteen ulnar styloid fractures had united, and 20 had not. There were no differences in demographic and injury characteristics. There were no significant differences in motion; strength; Gartland and Werley scores; Mayo scores; Disabilities of the Arm, Shoulder, and Hand scores; or pain scores 6 months after fracture.

CONCLUSIONS

Nonunion of a fracture of the proximal half of the ulnar styloid has no effect on wrist function, pain, and upper extremity-specific health status 6 months after volar plate fixation of a fracture of the distal radius.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic III.

Traumatic injuries of the distal radioulnar joint

Traumatic injuries of the distal radioulnar joint (DRUJ) may give rise to complex wrist pathologies. Substantial ongoing disability can arise should these injuries go unrecognized resulting in sub-optimal treatment and lack of appropriate rehabilitation. Injuries of the DRUJ may occur in isolation but more commonly are found with a fracture of the radius. These challenging DRUJ injuries may be simple or complex (irreducible or severe instability), acute or chronic. An adequate knowledge of the stabilizers of the DRUJ is essential in understanding treatment options. Traumatic instability of the DRUJ is reviewed and the anatomy and stabilizing factors are discussed. An algorithm to guide selection of treatment options in complex cases is presented.

Should an ulnar styloid fracture be fixed following volar plate fixation of a distal radial fracture?

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 (< or =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 and Disabilities 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.

The effect of ulnar styloid fractures on patient-rated outcomes after volar locking plating of distal radius fractures

PURPOSE

Ulnar styloid fractures commonly occur with distal radius fractures (DRFs). Ulnar styloid fractures that involve the insertion of the radioulnar ligaments can cause distal radioulnar joint (DRUJ) instability, and the literature suggests that these fractures should be treated with open reduction internal fixation (ORIF). However, in the absence of DRUJ instability, the effects of ulnar styloid fractures are unknown. The purpose of this study is to evaluate the outcome of ulnar styloid fractures without DRUJ instability on patient-rated outcomes after DRF ORIF.

METHODS

Between 2003 and 2008, a cohort of DRF patients treated with volar plating was enrolled. Patients with DRUJ instability treated at the time of distal radius ORIF were excluded. Radiographs were evaluated to identify and characterize ulnar styloid fractures. Patient-rated outcomes were measured at 6 weeks, 3 months, 6 months, and 12 months postoperatively using the Michigan Hand Outcomes Questionnaire (MHQ). Regression analysis was performed to determine whether the presence of an ulnar styloid fracture, the size or displacement of the fracture, or the healing status of the fracture was predictive of MHQ scores.

RESULTS

One-hundred and forty-four patients were enrolled; 88 patients had ulnar styloid fractures. During the collection period, DRUJ instability was found intraoperatively in 3 patients; these patients had ulnar styloid ORIF and were not enrolled. The 144 patients with a stable DRUJ after DRF ORIF maintained DRUJ stability after surgery. In these patients, the presence of an ulnar styloid fracture did not affect MHQ scores. Furthermore, the size of the ulnar styloid fracture, the degree of displacement, and the healing status of the ulnar styloid did not affect MHQ scores.

CONCLUSIONS

In patients with a stable DRUJ after DRF ORIF ulnar styloid fractures did not affect subjective outcomes as measured by the MHQ.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic III.

Distal radius fractures

Distal radius fractures are a common injury, particularly in the elderly population. Severity of these fractures is directly related to the bone mineral density of the patient, and clinical results are dependent on this parameter as well. In terms of treatment, several options exist. Nonoperative management consists of closed treatment with casting. Operative treatment options include intrafocal pinning, nonbridging and bridging external fixation, arthroscopic-assisted external fixation, and various methods of open reduction internal fixation. When operative intervention is indicated, considerations include the characteristics of the fracture and the experience of the surgeon with the treatment modalities.

WITHDRAWN: Surgical interventions for treating distal radial fractures in adults

BACKGROUND

Fracture of the distal radius is a common clinical problem, particularly in older white women with osteoporosis.

OBJECTIVES

To determine when, and if so what type of, surgical intervention is the most appropriate treatment for fractures of the distal radius in adults.

SEARCH STRATEGY

We searched the Cochrane Bone, Joint and Muscle Trauma Group specialised register (November 2002), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to 2003 Week 8), CINAHL (1982 to February 2003), the National Research Register (Issue 1, 2003), PEDro, conference proceedings and reference lists of articles. No language restrictions were applied.

SELECTION CRITERIA

Randomised or quasi-randomised clinical trials involving skeletally mature patients with a fracture of the distal radius, which compared surgical treatment with conservative treatment, different types of surgical intervention or the duration of immobilisation after surgery. The main categories of surgical intervention were external fixation, percutaneous pinning, open reduction and internal fixation, and the insertion of bone scaffolding materials.

DATA COLLECTION AND ANALYSIS

All trials, meeting the selection criteria, were independently assessed by both reviewers for methodological quality. Data were extracted for anatomical, functional and clinical outcomes (including complications). The trials were grouped into categories relating to the main comparisons and types of surgical intervention. Despite clear heterogeneity in the characteristics of comparable trials, pooling of data was undertaken where possible and appropriate.

MAIN RESULTS

Forty eight trials, examining 25 treatment comparisons, met the inclusion criteria of this review. These involved a total of 3371 mainly female and older patients with generally displaced, often comminuted and potentially or evidently unstable fractures. Nearly half of the trials compared surgery with plaster cast immobilisation. Summarising the outcomes was hampered by the variation between the studies in participant characteristics, interventions, quality of trial methodology and reporting, and outcome measurement. Surgical methods were usually associated with better anatomical appearance after fracture healing, but there was inadequate evidence to confirm that these had resulted in better functional and clinical outcomes for the patients.

AUTHORS' CONCLUSIONS

The 48 randomised trials do not provide robust evidence for most of the decisions necessary in the management of these fractures. Although, in particular, there is some evidence to support the use of external fixation or percutaneous pinning, their precise role and methods are not established. It is also unclear whether surgical intervention of most fracture types will produce consistently better long-term outcomes.There is a need for good quality evidence for the surgical management of these fractures.

Effect of an unrepaired fracture of the ulnar styloid base on outcome after plate-and-screw fixation of a distal radial fracture

BACKGROUND

The impact of an unrepaired fracture of the ulnar styloid base on recovery after internal fixation of a fracture of the distal part of the radius is uncertain. We evaluated a series of patients with an internally fixed fracture of the distal part of the radius to test the hypothesis that there is no difference in wrist motion or function scores between those with an untreated fracture of the ulnar styloid base and those with no ulnar fracture.

METHODS

Two cohorts of seventy-six matched patients, one with a fracture of the ulnar styloid base and the other with no ulnar fracture, were retrospectively analyzed by examining data gathered in a prospective study of plate-and-screw fixation of distal radial fractures. Patients were matched for age, sex, AO fracture type, and injury mechanism. The two cohorts were analyzed for differences in motion, grip strength, pain, the Gartland and Werley score, the DASH (Disabilities of the Arm, Shoulder and Hand) score, and the SF-36 (Short Form-36) score at six, twelve, and twenty-four months postoperatively. In a second analysis, sixty-four patients with <2 mm of displacement of a fracture of the ulnar styloid base were compared with forty-nine patients with greater displacement. Differences between cohorts and within cohorts over time were determined with use of regression analysis and the likelihood ratio test.

RESULTS

No significant differences were found between patients with an unrepaired fracture of the ulnar styloid base and those with no ulnar fracture at any of the follow-up intervals. However, a trend was observed toward less grip strength at six months (71% [of that on the contralateral side] compared with 79%; mean difference, -8% [95% confidence interval=-15.3% to -0.6%]; p=0.03) and less flexion (54 degrees compared with 59 degrees ; mean difference, -5 degrees [95% confidence interval=-11.7 degrees to -0.8 degrees ]; p=0.02) and ulnar deviation (32 degrees compared with 36 degrees ; mean difference, -4 degrees [95% confidence interval=-7 degrees to -0.1 degrees ]; p=0.05) at twenty-four months after surgery in patients with an untreated fracture of the ulnar styloid base. There were no significant differences with regard to any tested outcome measure between the patients with >or=2 mm of displacement of an unrepaired fracture of the ulnar styloid base and those with less displacement.

CONCLUSIONS

An unrepaired fracture of the base of the ulnar styloid does not appear to influence function or outcome after treatment of a distal radial fracture with plate-and-screw fixation, even when the ulnar fracture was initially displaced >or=2 mm.

The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius

A total of 118 consecutive patients with a fracture of the distal radius were treated with a volar locking plate; 50 patients had no ulnar styloid fracture, 41 had a basal ulnar styloid fracture, and 27 had a fracture of the tip of the ulnar styloid. There were no significant differences in radiological and clinical results among the three groups. The outcome was good and was independent of the presence of a fracture of the ulnar styloid. A total of five patients (4.2%) had persistent ulnar-sided wrist pain at final follow-up. Nonunion of the ulnar styloid fracture did not necessarily lead to ulnar wrist pain. Patients with persistent ulnar pain had a higher mean initial ulnar variance and increased post-operative loss of ulnar variance.

The presence of an associated ulnar styloid fracture of the ulnar styloid does not adversely affect the outcome in patients with a fracture of the distal radius treated by volar plating.

Assessment of distal radioulnar joint instability after distal radius fracture: comparison of computed tomography and clinical examination results

PURPOSE

To compare computed tomography (CT) and clinical stress test findings in terms of the assessment of distal radioulnar joint (DRUJ) instability after distal radius fracture.

METHODS

Thirty-four patients with a healed unilateral distal radius fracture were evaluated after a mean follow-up period of 18 months. Stress test and CT were performed to detect DRUJ instability. Three CT methods were used: the modified radioulnar line, the epicenter, and the radioulnar ratio methods. The results of CT assessments were compared with stress test findings using kappa statistics. Relationships between DRUJ instability and the radiographic parameters of volar tilt, radial inclination, and radial shortening were analyzed.

RESULTS

Twelve patients were considered to have DRUJ instability based on the stress test. DRUJ instability was diagnosed in 15, 8, and 11 patients by the modified radioulnar line, the epicenter, and the radioulnar ratio methods, respectively. Reliability analysis of stress test and CT results showed moderate or fair agreement (kappa value: .33 for the modified radioulnar line, .56 for the epicenter, .41 for the radioulnar ratio). DRUJ instability diagnosed by the stress test and by CT showed no statistical correlation with radiographic parameters, but instability determined by CT appeared to be related to dorsal tilt deformity.

CONCLUSIONS

After distal radius fracture, CT assessments of DRUJ instability were found to be influenced by residual deformities, such as dorsal tilt, but not well correlated with stress test findings. Although CT assessments are objective, CT scans primarily show alterations of DRUJ alignment and have several risks of bias in patients with a prior distal radius fracture.

Traumatic injuries of the distal radioulnar joint

Traumatic injuries of the distal radioulnar joint (DRUJ) may give rise to complex wrist pathologies. Substantial ongoing disability can arise should these injuries go unrecognized resulting in sub-optimal treatment and lack of appropriate rehabilitation. Injuries of the DRUJ may occur in isolation but more commonly are found with a fracture of the radius. These challenging DRUJ injuries may be simple or complex (irreducible or severe instability), acute or chronic. An adequate knowledge of the stabilizers of the DRUJ is essential in understanding treatment options. Traumatic instability of the DRUJ is reviewed and the anatomy and stabilizing factors are discussed. An algorithm to guide selection of treatment options in complex cases is presented.

Arthroscopic management of distal radius fractures

Arthroscopy has the advantage of providing a direct and accurate assessment of the articular surfaces and detecting the presence of injuries associated with distal radius fractures. Current indications, although numerous and potentially expanding, also are controversial. This report presents a global view of the current status of arthroscopy in the management of distal radius fractures. The rationale of arthroscopic treatment, the available evidence, and finally the diagnosis and treatment are discussed.

Distal radius fractures: a comparison of tension band wiring versus ulnar outrigger external fixation for the management of distal radioulnar instability

PURPOSE

To retrospectively compare the results of immobilization of the forearm in supination with the results of tension band fixation of the ulnar styloid in 35 patients with distal radius fractures, fracture of the base of the ulnar styloid, and distal radioulnar joint instability treated with external fixation.

METHODS

Thirty-five patients with fractures of the distal radius, fracture of the base of the ulnar styloid, and unstable distal radioulnar joint had external fixation with adjunctive percutaneous pins and allograft bone to reduce and stabilize the distal radius fracture anatomically. Only those patients with an associated ulnar styloid base fracture displaced over 2 mm with gross distal radioulnar joint instability relative to the contralateral wrist were included in this study. Group 1 consisted of patients in whom the ulnar styloid base fracture was treated with conventional tension band wiring techniques. Group 2 patients were treated with a supplemental outrigger from the external fixator to the ulna and locked in 60 degrees of forearm supination. Groups 1 and 2 had an average follow-up period of 40 and 36 months, respectively.

RESULTS

Group 2 had significantly better supination than group 1. In terms of functional outcome it was found that there was no significant difference for the Disabilities of the Arm, Shoulder, and Hand and the Gartland and Werley scores between the 2 treatment groups. There was a lower rate of complications and fewer secondary procedures were required in group 2. The incidence of distal ulna resection was 4 of the 35 patients (2 patients in each group).

CONCLUSIONS

Our results indicate that patients in whom the ulnar styloid can be reduced and maintained in supination can be treated effectively with fixed supination outrigger external fixation. This method resulted in a statistically significant improvement in supination and a lower rate of distal radioulnar joint complications, and it required fewer secondary procedures.

Treatment of injuries to the ulnar side of the wrist occurring with distal radial fractures

We still do not know how to best treat the DRUJ condition that was recognized 200 years ago by Abraham Colles and later addressed in Frykman's classic thesis. To improve the outcome, we must recognize the differences be-tween osteoporotic and other fractures and understand the importance of ligament injuries,especially in patients under the osteoporotic age. However, our current problem is that neither the initial ligament injury nor the posttraumatic laxity is detectable with radiographic methods,which creates future challenges regarding diagnosis and treatment. We therefore have to critically analyze each fracture in each patient and be aware of the complexity of the entire injury to the wrist.

Surgical interventions for treating distal radial fractures in adults

BACKGROUND

Fracture of the distal radius is a common clinical problem, particularly in older white women with osteoporosis.

OBJECTIVES

To determine when, and if so what type of, surgical intervention is the most appropriate treatment for fractures of the distal radius in adults.

SEARCH STRATEGY

We searched the Cochrane Musculoskeletal Injuries Group specialised register (November 2002), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to 2003 Week 8), CINAHL (1982 to February 2003), the National Research Register (Issue 1, 2003), PEDro, conference proceedings and reference lists of articles. No language restrictions were applied.

SELECTION CRITERIA

Randomised or quasi-randomised clinical trials involving skeletally mature patients with a fracture of the distal radius, which compared surgical treatment with conservative treatment, different types of surgical intervention or the duration of immobilisation after surgery. The main categories of surgical intervention were external fixation, percutaneous pinning, open reduction and internal fixation, and the insertion of bone scaffolding materials.

DATA COLLECTION AND ANALYSIS

All trials, meeting the selection criteria, were independently assessed by both reviewers for methodological quality. Data were extracted for anatomical, functional and clinical outcomes (including complications). The trials were grouped into categories relating to the main comparisons and types of surgical intervention. Despite clear heterogeneity in the characteristics of comparable trials, pooling of data was undertaken where possible and appropriate.

MAIN RESULTS

Forty eight trials, examining 25 treatment comparisons, met the inclusion criteria of this review. These involved a total of 4371 mainly female and older patients with generally displaced, often comminuted and potentially or evidently unstable fractures. Nearly half of the trials compared surgery with plaster cast immobilisation. Summarising the outcomes was hampered by the variation between the studies in participant characteristics, interventions, quality of trial methodology and reporting, and outcome measurement. Surgical methods were usually associated with better anatomical appearance after fracture healing, but there was inadequate evidence to confirm that these had resulted in better functional and clinical outcomes for the patients.

REVIEWER'S CONCLUSIONS

The 48 randomised trials do not provide robust evidence for most of the decisions necessary in the management of these fractures. Although, in particular, there is some evidence to support the use of external fixation or percutaneous pinning, their precise role and methods are not established. It is also unclear whether surgical intervention of most fracture types will produce consistently better long-term outcomes. There is a need for good quality evidence for the surgical management of these fractures.

Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability

Ulnar-sided injuries of the wrist have received more attention recently for their potential negative impact on the outcome of distal radius fractures. Radiographs and medical records were retrospectively reviewed for 166 distal radius fractures treated during a 1-year interval. Distal radius fractures were classified according to the AO system, and accompanying ulnar styloid fractures were evaluated for both size and displacement. Each distal radius fracture was also evaluated for radiographic and clinical evidence of distal radioulnar joint instability. The distribution of ulnar styloid fractures was not random; greater than one third involved the base. All distal radius fractures complicated by distal radioulnar joint instability were accompanied by an ulnar styloid fracture. A fracture at the ulnar styloid's base and significant displacement of an ulnar styloid fracture were found to increase the risk of distal radioulnar joint instability.

The radioulnar joint in distal radial fractures

We searched The Cochrane Library and Medline regarding the radioulnar joint in distal radial fractures and found no randomized or controlled studies. This review presents the descriptive literature by summarizing accepted views and controversies. There is only weak support for the commonly accepted treatments. Current research has shown that distal radial fractures are often associated with ligament injuries not seen on radiographs. These injuries can lead to laxity of the DRU-joint and subsequent worse outcome, which indicates that we must have a complete diagnosis including ligament injuries if we want to understand better the fracture and its sequelae. Randomized studies should be done before advocating surgical treatment of these unforeseen injuries.

Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures

The aim of this prospective study was to determine whether peripheral tears of the triangular fibrocartilage complex (TFCC) in patients younger than the osteoporotic age (males,<60 years; females, <50 years) were related to chronic distal radioulnar joint (DRUJ) instability. Fifty-one patients (27 women) with displaced distal radial fractures were included in the study. The median age was 41 years (range, 20-57 years). Arthroscopy at the time of fracture showed complete or partial TFCC tears in 43 patients (24 had only peripheral tears, 10 had only central perforations, and 9 had combined tears). The 1-year (range, 11-27 months) follow-up period included an interview, physical examination, and radiographic evaluation. Ten of the 11 patients with complete peripheral TFCC tears had DRUJ instability at the follow-up examination compared with 7 of the 32 patients with only partial or no peripheral tears. Patients with instability of the DRUJ had a worse Gartland and Werley wrist score. Instability was not associated with any radiographic finding either at the time of fracture or at the follow-up examination. Initial fracture or nonunion of the styloid was even slightly more common in stable patients.

Triangular fibrocartilage injury: a laboratory model

A potential injury mechanism for triangular fibrocartilage tears and ulnar styloid fractures was investigated in cadaver specimens. The distal radioulnar joint was distracted to failure, thus applying a tensile force to the triangular fibrocartilage. During distraction, strains in the triangular fibrocartilage and the anatomic site of disruption were recorded with an image analysis system. Complete avulsion of the triangular fibrocartilage from the ulnar head occurred in 7 of 10 specimens. No ulnar styloid fractures occurred. Although strains were high in the radial portion of the disk (28%), no tears occurred in the substance of the disk or at its attachment to the radius. These findings suggest that distal radioulnar joint distraction can cause avulsion of the triangular fibrocartilage. However, ulnar styloid fractures and tears within the disk are more likely caused by injury mechanisms that include shear or compressive forces. Since complete avulsions of the triangular fibrocartilage occurred without a fracture, the absence of a fracture does not rule out a destabilizing injury to the distal radioulnar joint.

Poor correlation between functional results and radiographic findings in Colles' fracture

We reviewed 83 consecutive patients with unilateral Colles' fracture in order to identify factors that predict poor functional outcome. All fractures were treated by closed reduction and cast immobilization, and followed-up for at least 2 years. Our results showed that only final dorsal angulation was correlated to loss of flexion. In contrast to other reports, we could not find any relationship between radial shortening and loss of grip strength or loss of range of motion. In addition, the severity of initial displacement, involvement of radio-carpal or distal radio-ulnar joints, and the presence of ulnar styloid fractures or their non-union did not affect the functional outcome.