The Influence Of Ulnar Styloid Fractures On The Outcome Of Distal Radial Fractures Treated With External Fixation

Background and Objective The distal radius fracture is a common injury. For the unstable distal fracture which conservative treatment is difficult to achieve satisfactory reduction and effective fixation, It often requires operative treatment A wide range of fixation choices, such as locking-plate, external fixation, Kirschner-wire(K-wire), or the combination of these methods, are available for the unstable distal radius fracture. Given that external fixation is less invasive compared with other methods, it is generally agreed that external fixation plays an importment role in treating the unstable distal radius fracture. The distal radius fracture is frequently associated with an ulnar styloid fracture. For the ulnar styloid fracture the treatment remains controversial, some experts think the ulnar styloid fracture requires open reduction and internal fixation. On the contrary, some others the ulnar styloid fracture requires nothing treatment. In our study, we expect to investigate the influence of the untreated ulnar styloid fractures on the outcome of unstable distal radial fractures treated with external fixation.Materials and Methods 118 patients of unstable distal radial fractures who were treated in Drum Tower Hospital in January 2009 to December 2011 were included in this study. The patients were divided into three groups according to the location of the ulnar styloid fracture:Group A (the base-fracture), Group B (the tip-fracture) and Group C (non-fracture). All the patients were treated with external fixation, leaving ulnar styloid fractures untreated. The external fixator was removed 6-8 weeks after surgery. Postoperative evaluation included the radiological parameters, the range of wrist motion, and the Gartland-Werley scores at the final follow-up.Results The patients were followed for 12 to 24 months (15.3 months in average), all 118 unstable DRF had united at final follow-up.79 of 118 patients had ulnar styloid fracture and 19 patients (28%) showed radiographic evidence of the union of ulnar styloid fractures at the final follow-up. The union rate of the ulnar styloid fracture was 28%(13 of 46 patients) in base-fracture group, and 26%(6 of 23 patients) in the tip-fracture group with no significant difference detected between the two groups(P=0.849). No significant differences was detected at the final follow-up in terms of the radiological findings, range of wrist motion, the Gartland-Werley scores among the three groups.Conclusion The unstable DRFs treated with external fixation have good outcomes and lower complications. When the distal radioulnar joint is stable, an ulnar styloid fracture accompanied by the unstable distal radial fracture treated with external fixation could be done without any treatment.