Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Moloney M, Farnebo S, Adolfsson L. Incidence of distal ulna fractures in a Swedish county: 74/100,000 person-years, most of them treated non-operatively. Acta Orthop. 2020;91(1):104–8.

    Article  Google Scholar 

  2. 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.

    Article  Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. 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.

    Article  Google Scholar 

  5. Hintringer W, Rosenauer R, Pezzei C, Quadlbauer S, Jurkowitsch J, Keuchel T, Hausner T, Leixnering M, Krimmer H. Biomechanical considerations on a CT-based treatment-oriented classification in radius fractures. Arch Orthop Trauma Surg. 2020;140(5):595–609.

    Article  CAS  Google Scholar 

  6. Quadlbauer S, Pezzei C, Jurkowitsch J, Rosenauer R, Pichler A, Schättin S, Hausner T, Leixnering M. Functional and radiological outcome of distal radius fractures stabilized by volar-locking plate with a minimum follow-up of 1 year. Arch Orthop Trauma Surg. 2020;140(6):843–52.

    Article  Google Scholar 

  7. Kwon BC, Seo BK, Im HJ, Baek GH. Clinical and radiographic factors associated with distal radioulnar joint instability in distal radius fractures. Clin Orthop Relat Res. 2012;470(11):3171–9.

    Article  Google Scholar 

  8. Gogna P, Selhi HS, Mohindra M, Singla R, Thora A, Yamin M. Ulnar styloid fracture in distal radius fractures managed with volar locking plates: to fix or not? J Hand Microsurg. 2014;6(2):53–8.

    Article  Google Scholar 

  9. Meyer H, Krämer S, O’Loughlin PF, Vaske B, Krettek C, Gaulke R. Union of the ulnar styloid fracture as a function of fracture morphology on conventional radiographs. Skeletal Radiol. 2013;42(8):1135–41.

    Article  CAS  Google Scholar 

  10. Wijffels MM, Keizer J, Buijze GA, Zenke Y, Krijnen P, Schep NW, Schipper IB. Ulnar styloid process nonunion and outcome in patients with a distal radius fracture: a meta-analysis of comparative clinical trials. Injury. 2014;45(12):1889–95.

    Article  CAS  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. 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.

    Article  CAS  Google Scholar 

  13. Tanabe K, Nakajima T, Sogo E, Denno K, Horiki M, Nakagawa R. Intra-articular fractures of the distal radius evaluated by computed tomography. J Hand Surg Am. 2011;36(11):1798–803.

    Article  Google Scholar 

  14. van Valburg MK, Wijffels MM, Krijnen P, Schipper IB. Impact of ulnar styloid fractures in nonoperatively treated distal radius fractures. Eur J Trauma Emerg Surg. 2013;39(2):151–7.

    Article  Google Scholar 

  15. Sun GTW, MacLean SBM, Alexander JJ, Woodman R, Bain GI. Association of scapholunate dissociation and two-part articular fractures of the distal radius. J Hand Surg Eur. 2019;44(5):468–74.

    Article  Google Scholar 

  16. Bain GI, Alexander JJ, Eng K, Durrant A, Zumstein MA. Ligament origins are preserved in distal radial intraarticular two-part fractures: a computed tomography-based study. J Wrist Surg. 2013;2(3):255–62.

    Article  Google Scholar 

  17. Petracić B, Siebert H. AO-classification of fractures of the hand bones. Handchir Mikrochir Plast Chir. 1998;30(1):40–4.

    PubMed  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. Berger RA. The anatomy of the ligaments of the wrist and distal radioulnar joints. Clin Orthop Relat Res. 2001;383:32–40.

    Article  Google Scholar 

  20. Ishii S, Palmer AK, Werner FW, Short WH, Fortino MD. An anatomic study of the ligamentous structure of the triangular fibrocartilage complex. J Hand Surg Am. 1998;23(6):977–85.

    Article  CAS  Google Scholar 

  21. Schuind F, An KN, Berglund L, Rey R, Cooney WP 3rd, Linscheid RL, Chao EY. The distal radioulnar ligaments: a biomechanical study. J Hand Surg Am. 1991;16(6):1106–14.

    Article  CAS  Google Scholar 

  22. Kim JK, Yun YH, Kim DJ, Yun GU. Comparison of united and nonunited fractures of the ulnar styloid following volar-plate fixation of distal radius fractures. Injury. 2011;42(4):371–5.

    Article  Google Scholar 

  23. Yuan C, Zhang H, Liu H, Gu J. Does concomitant ulnar styloid fracture and distal radius fracture portend poorer outcomes? A meta-analysis of comparative studies. Injury. 2017;48(11):2575–81.

    Article  Google Scholar 

Download references

Acknowledgements

This study was funded by Japan Society for the Promotion of Science (Grant number JP20K11214).

Author information

Authors and Affiliations

  1. Saiseikai Shigaken Hospital, Ritto, Japan

    Shinsuke Morisaki, Shinji Tsuchida, Ryo Oda & Kenji Takahashi

Authors
  1. Shinsuke Morisaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shinji Tsuchida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ryo Oda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kenji Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shinsuke Morisaki.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research and ethics committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Availability of data and material

The datasets used during the current study are not publicly available because of patient confidentiality but are available from the corresponding author on reasonable request.

Consent to participate

Not applicable to that section.

Consent for publication

All the authors have seen and approved the final manuscript and have given their consent for publication.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morisaki, S., Tsuchida, S., Oda, R. et al. Conservative treatment of ulnar styloid fractures following volar-plate fixation of distal radius fractures: incidence of nonunion evaluated by computed tomography. Eur J Trauma Emerg Surg 48, 2247–2254 (2022). https://doi.org/10.1007/s00068-021-01770-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-021-01770-5

Keywords

Search

Navigation