Abstract
Purpose
The effect of an ulnar styloid fracture (USF) on the stability of nonoperatively treated distal radius fractures (DRF) is unknown. The aim of this study was to evaluate the influence of USFs on the dislocation of DRFs treated by closed reduction.
Methods
Standardized radiographs of 100 nonoperatively treated DRFs were evaluated. DRFs with a USF were compared to DRFs without a USF with respect to dorsal tilt, radial inclination, and ulnar variance.
Results
We evaluated the radiographs of 100 DRFs in 99 consecutive patients, of whom 84 were women. An accompanying USF was present in 58 wrists, of which 49 were displaced. On the trauma radiograph, the USF group showed significantly more overall dislocation. After closed reduction, fracture position improved, and no significant differences in dislocation were observed between groups. After a mean of 42 days, radial inclination significantly decreased if a USF was present. When USF displacement was taken into account, significantly more ulnar variance occurred in the displaced USF group on the trauma and follow-up radiograph compared to the nondisplaced USF group and no-USF group.
Conclusions
The results of this study show that presence of a dislocated USF in patients with a DRF is associated with a worse position directly after trauma, and with recurrence of radial shortening after adequate reduction. These results warrant early radiologic follow-up in patients with reduced combined DRFs and USFs in order to evaluate the redislocation of the distal radius. Early detection of redislocation in these combined fractures may induce early surgical intervention.
Similar content being viewed by others
References
Hollingsworth R, Morris J. The importance of the ulnar side of the wrist in fractures of the distal end of the radius. Injury. 1976;7(4):263–6.
Lindau TR, Aspenberg P, Arner M, Redlundh-Johnell I, Hagberg L. Fractures of the distal forearm in young adults. An epidemiologic description of 341 patients. Acta Orthop Scand. 1999;70(2):124–8.
Sammer DM, Shah HM, Shauver MJ, Chung KC. The effect of ulnar styloid fractures on patient-rated outcomes after volar locking plating of distal radius fractures. J Hand Surg Am. 2009;34(9):1595–602.
Frykman G. Fracture of the distal radius including sequelae—shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand. 1967;108(Suppl):7–153
Lindau T, Arner M, Hagberg L. Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg Br. 1997;22(5):638–43.
Oskarsson GV, Aaser P, Hjall A. Do we underestimate the predictive value of the ulnar styloid affection in Colles fractures? Arch Orthop Trauma Surg. 1997;116(6–7):341–4.
Richards RS, Bennett JD, Roth JH, Milne K Jr. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg Am. 1997;22(5):772–6.
Kleinman WB. Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years. J Hand Surg Am. 2007;32(7):1086–106.
Mikic ZD. Detailed anatomy of the articular disc of the distal radioulnar joint. Clin Orthop Relat Res. 1989;245:123–32.
Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist—anatomy and function. J Hand Surg Am. 1981;6(2):153–62.
Adams BD, Samani JE, Holley KA. Triangular fibrocartilage injury: a laboratory model. J Hand Surg Am. 1996;21(2):189–93.
Hauck RM, Skahen J III, Palmer AK. Classification and treatment of ulnar styloid nonunion. J Hand Surg Am. 1996;21(3):418–22.
Haugstvedt JR, Berger RA, Nakamura T, Neale P, Berglund L, An KN. Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint. J Hand Surg Am. 2006;31(3):445–51.
Kikuchi Y, Nakamura T. Avulsion fracture at the fovea of the ulna. A report of two cases. J Hand Surg Br. 1998;23:176–8.
May MM, Lawton JN, Blazar PE. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg Am. 2002;27(6):965–71.
Zimmermann R, Rudisch A, Fritz D, Gschwentner M, Arora R. MR imaging for the evaluation of accompanying injuries in cases of distal forearm fractures in children and adolescents. Handchir Mikrochir Plast Chir. 2007;39(1):60–7.
Lafontaine M, Hardy D, Delince P. Stability assessment of distal radius fractures. Injury. 1989;20(4):208–10.
Geissler WB, Fernandez DL, Lamey DM. Distal radioulnar joint injuries associated with fractures of the distal radius. Clin Orthop Relat Res. 1996;327:135–46.
Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res. 1984;187:26–35.
Stoffelen D, De SL, Broos P. The importance of the distal radioulnar joint in distal radial fractures. J Hand Surg Br. 1998;23(4):507–11.
Porter M, Stockley I. Fractures of the distal radius. Intermediate and end results in relation to radiologic parameters. Clin Orthop Relat Res. 1987;220:241–52.
van der Linden W, Ericson R. Colles’ fracture. How should its displacement be measured and how should it be immobilized? J Bone Jt Surg Am. 1981;63(8):1285–8.
Schuind FA, Linscheid RL, An KN, Chao EY. A normal data base of posteroanterior roentgenographic measurements of the wrist. J Bone Jt Surg Am. 1992;74(9):1418–29.
Adams BD. Effects of radial deformity on distal radioulnar joint mechanics. J Hand Surg Am. 1993;18(3):492–8.
Buijze GA, Ring D. Clinical impact of united versus nonunited fractures of the proximal half of the ulnar styloid following volar plate fixation of the distal radius. J Hand Surg Am. 2010;35(2):223–7.
Kim JK, Koh YD, Do NH. Should an ulnar styloid fracture be fixed following volar plate fixation of a distal radial fracture? J Bone Jt Surg Am. 2010;92(1):1–6.
Souer JS, Ring D, Matschke S, Audige L, Marent-Huber M, Jupiter JB. Effect of an unrepaired fracture of the ulnar styloid base on outcome after plate-and-screw fixation of a distal radial fracture. J Bone Jt Surg Am. 2009;91(4):830–8.
Zenke Y, Sakai A, Oshige T, Moritani S, Nakamura T. The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius. J Bone Jt Surg Br. 2009;91(1):102–7.
Gartland JJ, Werley CW. Evaluation of healed Colles’ fractures. J Bone Jt Surg Am. 1951;33-A(4):895–907.
Gelberman RH, Salamon PB, Jurist JM, Posch JL. Ulnar variance in Kienbock’s disease. J Bone Jt Surg Am. 1975;57(5):674–6.
Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Jt Surg Am. 1986;68(5):647–59.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
van Valburg, M.K., Wijffels, M.M.E., Krijnen, P. et al. Impact of ulnar styloid fractures in nonoperatively treated distal radius fractures. Eur J Trauma Emerg Surg 39, 151–157 (2013). https://doi.org/10.1007/s00068-013-0256-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-013-0256-8