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Distal radius fracture with concomitant ulnar styloid fracture: does distal radioulnar joint stability depend on the location of the ulnar styloid fracture?

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Studies are conflicting regarding the relationship between ulnar styloid fracture (USF) location and distal radioulnar joint (DRUJ) instability in patients with distal radius fracture (DRF) and concomitant USF. The objective of this study was to determine the association of USF location with TFCC foveal tear and factors associated with DRUJ instability in patients with both DRF and USF.

Materials and methods

Fifty-four patients with both DRF and USF who had wrist MRI examination before surgery were analyzed. USF location (tip or base) and TFCC foveal insertion status (intact, partial tear, or complete tear or avulsion with fractured fragment) were evaluated. DRUJ stability was assessed intra-operatively after fixation of the radius. Factors potentially associated with DRUJ instability, such as age, gender, USF location, USF fragment gap, radioulnar distance, radial shortening, and TFCC foveal tear, were analyzed.

Results

Among 54 patients, 37 (69%) and 17 (31%) had USF at the base and the tip, respectively. In patients with base fractures, TFCC foveal insertion was found to be disrupted in 89% (33/37) patients (complete tear in 11 and partial tear in 22) but intact in 11% (4/37). On the contrary, in patients with tip fractures, the insertion was found to be disrupted in 88% (15/17) patients (complete tear in 2 and partial tear in 13) but intact in 12% (2/17). After fixation of the radius, total 52% (28/54) patients showed DRUJ instability. Especially, DRUJ instability was found in 57% (21/37) of ulna styloid process base fracture patients and 41% (7/17) of ulna styloid process tip fracture patients. In univariate analysis, complete tear of TFCC foveal insertion and wider USF fragment distance were associated with DRUJ instability.

Conclusions

Tears of TFCC foveal insertion are common in patients with DRF and concomitant ulnar styloid base fractures. Based on the findings of this study, tear of TFCC foveal insertion seems to be also common in patients with DRF and concomitant ulnar styloid tip fractures. And also, DRUJ instability seems to be associated with a TFCC foveal tear independent of USF location.

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Availability of data and materials

The data sets used and analysed during the current study are available from the corresponding author on reasonable request.

Code availability

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Acknowledgements

We received statistical support from professor Seung Hyun Won of Medical Research Collaborating Center (MRCC) at Seoul National University Bundang Hospital. This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science and ICT).

Funding

This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science and ICT) (Grant No. 2020R1A2C1005778).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, South Korea

    Kyung Wook Kim

  2. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea

    Che Ho Lee, Jae Heouk Choi & Hyun Sik Gong

  3. Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea

    Joong Mo Ahn

  4. Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea

    Hyun Sik Gong

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  1. Kyung Wook Kim
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Kyung Wook Kim, Che Ho Lee, Jae Heouk Choi, Joong Mo Ahn and Hyun Sik Gong. The first draft of the manuscript was written by Kyung Wook Kim and Hyun Sik Gong. All authors read and approved the final manuscript.

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Correspondence to Hyun Sik Gong.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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This study obtained institutional review board approval from Seoul National University Bundang Hospital (SNUBH IRB-B-2009/637-104).

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Kim, K.W., Lee, C.H., Choi, J.H. et al. Distal radius fracture with concomitant ulnar styloid fracture: does distal radioulnar joint stability depend on the location of the ulnar styloid fracture?. Arch Orthop Trauma Surg 143, 839–845 (2023). https://doi.org/10.1007/s00402-021-04199-y

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