Surgical Versus Nonsurgical Treatment of Ulnar Styloid Fractures in the Context of Distal Radius Fractures

Abstract

Objective: The objective of this study was to compare surgical versus nonsurgical treatment of ulnar styloid fractures occurring in the context of distal radius fractures treated by open reduction and internal fixation (ORIF) with volar locked plates. Methods: A multicenter retrospective study, including four different level I trauma centers, was carried out. Patients operated on between 2009 and 2012, with ulnar styloid fractures, in the context of an unstable displaced distal radius fracture that had ORIF with a volar locked plate were included; they were divided into two groups according to whether the ulnar styloid fracture was treated nonsurgically (group I) or surgically (group II). Only patients in which distal radius fracture reduction after ORIF was considered anatomical were included. Ulnar styloid fractures were classified according to Rotella’s classification. Results: Fifty-seven patients were included in the study (group I: 29, group II: 28). Follow-up averaged 55.98 months and was different between groups (group I: 63.14 months SD, 1.95, and group II: 48.43 months SD, 3.74), averaging 14.5 months (SD, 4.5) less in group II ( P = .001). Patient’s age averaged 49.5 years (SD, 1.82) and was similar ( P = .225) between both groups. Women were more frequent in group II ( P = .0435). In 35% of patients, the dominant extremity was operated; dominance was different ( P = .0501) between groups (28% in group I and 42% in group II). According to Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification in group I, there were 10 type A, 1 type B, and 18 type C fractures, whereas in group II, there were 7 type A, 5 type B, and 16 type C fractures. Ulnar styloid fractures were located at its base in 28 patients, middle third in 19 patients, and tip in 10 patients. Ulnar styloid classification distribution evidenced differences between groups ( P = .020); while in group I, there was homogeneous frequency of proximal and tip fractures, and most fractures in group II were proximal. Styloid fracture union chance was statistically significantly different ( P = .054; styloid fracture united in 14 of the 29 cases of group I and in 19 of the 28 cases of group II); patients in group II had 2.76 (95% confidence interval [CI], 1.086-8.80) more chances of uniting than those in group I. Disability of the Arm, Shoulder and Hand (DASH) score and Visual Analog Scale (VAS) pain score (at rest and during activities) did not show significant differences between groups (DASH, P = .276; VAS at rest, P = .877; and VAS during activities, P = .681). Ulnar deviation and strength at last follow-up evidenced better results in group I ( P = .0389 and P = .024, respectively). Postoperative immobilization, performed using long-arm or short-arm, casts or braces, was different in the groups ( P < .001); 41% of patients in group I had a long-arm cast and the rest a short-arm brace, whereas 95% of patients in group II had braces. There were no significant differences in time of postoperative immobilization ( P = .469). Conclusion: In this multicenter study, no significant differences between surgical and nonsurgical treatment of ulnar styloid fractures occurring in the context of distal radius fractures treated by ORIF with volar locked plates were evidenced. Anatomical reduction of distal radius fractures remains the most important objective in treating these lesions.