Distal Radius Fracture

Abstract

Introduction: Distal radius fractures (DRFs) are often accompanied by an associated fracture at the base of the ulnar styloid. The base of the ulnar styloid is an anchor for the deep portion of the Triangular Fibrocartilage Complex (TFCC), which helps to stabilize the distal radio ulnar joint. In our hospital, TFCC injuries and basal ulnar styloid fractures are not primarily operated, but only secondarily in case of symptomatic instability. Objectives: The objective was to test whether the outcome differed between patients with or without a basal ulnar styloid fracture after internal fixation. Methods: Scrutinizing the radiograms of the patients in our prospective register of all DRFs in patients 18 years and older, 65 operated patients were identified having an Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C fracture operated with internal fixation between January 2008 and June 2010. Patients with a simultaneous fracture at the base of the ulnar styloid and patients with unaffected ulnar styloid were invited to a clinical and radiographic examination and evaluated regarding wrist function (Quick Disability of the Arm, Shoulder and Hand [QuickDASH]); Visual Analog Scale (VAS) regarding pain at rest, work, and function; grip strength; range of motion (ROM); and the stability of the distal radio ulnar joint. In all, 45 patients were included; 7 patients declined to participate, and 3 patients could not be reached leaving 35 patients in the study groups. Results: Nineteen patients had a fractured styloid and 16 patients had an intact styloid. The ROM in the ulnar/radial deviation was better (93% vs 79% ( P = .003) in the patients with a fractured styloid compared with the uninjured. There were no differences in QuickDASH, VAS, stability, grip strength, or ROM in supination/pronation or flexion/extension. The mean follow-up time was 27 (15-40) months, and no patients were operated during this time due to distal radio ulnar joint (DRUJ) instability. Conclusion: Fracture at the base of the ulnar styloid did not worsen the outcome of wrist function and pain at medium to long time, in patients with AO type C fracture operated with internal fixation. It thus appears unnecessary to fix a fracture at the base of the ulnar styloid in these patients.