Radiographic Healing and Functional Outcomes of Untreated Ulnar Styloid Fractures following Volar Plate Fixation of Distal Radius Fractures: A Prospective Analysis
Michael Okoli, MD; Asif Ilyas, MD
Rothman Institute at Thomas Jefferson University, Philadelphia, PA
Ulnar styloid fractures (USF) are common concomitant injuries associated with distal radius fractures (DRF). Recent studies have found conflicting evidence on whether these fractures treated or untreated effect pain and functional outcomes. The purpose of this study was to prospectively evaluate pain and functional outcomes of consecutively untreated USFs in surgically repaired DRFs. We hypothesized that the presence of and treatment of USFs would have no effect on outcomes or reoperations.
A prospective study at a single institution of consecutive DRF treated surgically with volar locked plating was undertaken. Patients were scrutinized for the type of USF, and their ultimate effect on the Quick Disability of the Arm Shoulder and Hand (q-DASH) score and the Patient Rated Wrist Evaluation (PRWE) scores. Outcome measures were collected at 2 weeks, 3 months, and 1 year post-operatively.
A total of 306 consecutive cases were enrolled. There was an incidence of 48% (146/306) of surgically treated DRFs with an associated distal ulna fracture. By location, there were 65.8% tip, 27.4% base, and 6.8% neck USFs. Only tip and base fractures were subsequently analyzed. No tip or base USFs were surgically repaired. There was no statistical difference in q-DASH scores irrespective of type at any time point post-operatively. Similarly, no statistical difference in PRWE scores was seen irrespective of type at any time point post-operatively. By 1 year post-operatively, there were 53.8% of non-united USF. Nonunions occurred in 58.8% of tip, 42.9% of base, and 50% of neck USFs. Again, tip and base USF nonunions compared to united USFs also showed no difference in q-DASH and PRWE scores. Lastly, there was no difference in reoperation rate for any reason between patients with versus without an associated USF by final follow-up.
Ulnar styloid fractures are a common concomitant injury occurring in nearly half of distal radius fractures treated surgically, and over a half of these fractures go onto nonunions. Our prospective cohort analysis showed that neither the presence, type, nor bony union status of a concomitant USF has any significant effect on patient outcomes or reoperations. Our study confirms our hypothesis that USF of the tip and neck should be left untreated.
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