The Journal of Bone and Joint Surgery (American). 2009;91:830-838.
doi:10.2106/JBJS.H.00345
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Effect of an Unrepaired Fracture of the Ulnar Styloid Base on Outcome After Plate-and-Screw Fixation of a Distal Radial Fracture

J. Sebastiaan Souer, MD1, David Ring, MD, PhD1, Stefan Matschke, MD2, Laurent Audige, PhD3, Marta Marent-Huber3, Jesse B. Jupiter, MD1 and the AOCID Prospective ORIF Distal Radius Study Group*

1 Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114. E-mail address for D. Ring: dring{at}partners.org
2 BG Unfallklinik, Ludwig-Guttmann-Strasse 13, D-67071 Ludwigshafen, Germany
3 AO Clinical Investigation and Documentation, Stettbachstrasse 10, CH-8600 Zurich/Dübendorf, Switzerland

* The AOCID (AO Clinical Investigation and Documentation) Prospective ORIF Distal Radius Study Group includes Dr. Beate Hanson, MD, AOCID, Dübendorf, Switzerland; Dr. D. Rikli, Kantonspital Luzern, Switzerland; Prof. H.R. Siebert, Dakonie-Krankenhaus, Schwäbisch Hall, Germany; Dr. D.A. Campbell, St. James' University Hospital, Leeds, Great Britain; Dr. Teoh Lam-Chuan, Singapore General Hospital, Singapore; Dr. F. Torretta, Istituto Ortopedico Gaetano Pini, Milano, Italy; Dr. G. Lauri, Centro Traumatologico Ortopedico, Firenze, Italy; Dr. W. Hintriger, Krankenanstaltverbund Korneuburg-Stockerau, Austria; Dr. H. Drobetz, Unfallabteilung Krankenhaus Neunkirchen, Austria; Dr. M. Plecko, Abteilung Unfallchirurgie, UKH, Graz, Austria; Prof. A. Wentzensen, BG Unfallklinik, Ludwigshaven, Germany; Prof. D. Höntzsch, BG Unfallklinik, Tübingen, Germany; Prof. R.H. Neugebauer, Krankenhaus der Barmherzigen Brüder, Regensburg, Germany; Prof. N.P. Haas, Charité, Berlin, Germany; Prof. K.E. Rehm, Chirurgische Universitätsklinik, Köln, Germany; Prof. K.H. Winker, HELIOS Klinikum Unfallchirugie, Erfurt, Germany; Prof. W. Ertel, Universitätsklinik Benjamin Franklin, Berlin, Germany; Dr. Chr. Sommer, Rätisches Kantons- und Regionalspital, Chur, Switzerland; Prof. M. Wagner, Wilhelminenspital, Wien, Austria; and Prof. S.P. Chow, Queen Mary Hospital, Hong Kong.

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from Stichting Michael van Vloten Fonds and Stichting Anna Fonds as well as outside funding or grants of more than $10,000 from Small Bone Innovations, Smith and Nephew, Wright Medical, and the AO Clinical Investigation and Documentation. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: The impact of an unrepaired fracture of the ulnar styloid base on recovery after internal fixation of a fracture of the distal part of the radius is uncertain. We evaluated a series of patients with an internally fixed fracture of the distal part of the radius to test the hypothesis that there is no difference in wrist motion or function scores between those with an untreated fracture of the ulnar styloid base and those with no ulnar fracture.

Methods: Two cohorts of seventy-six matched patients, one with a fracture of the ulnar styloid base and the other with no ulnar fracture, were retrospectively analyzed by examining data gathered in a prospective study of plate-and-screw fixation of distal radial fractures. Patients were matched for age, sex, AO fracture type, and injury mechanism. The two cohorts were analyzed for differences in motion, grip strength, pain, the Gartland and Werley score, the DASH (Disabilities of the Arm, Shoulder and Hand) score, and the SF-36 (Short Form-36) score at six, twelve, and twenty-four months postoperatively. In a second analysis, sixty-four patients with <2 mm of displacement of a fracture of the ulnar styloid base were compared with forty-nine patients with greater displacement. Differences between cohorts and within cohorts over time were determined with use of regression analysis and the likelihood ratio test.

Results: No significant differences were found between patients with an unrepaired fracture of the ulnar styloid base and those with no ulnar fracture at any of the follow-up intervals. However, a trend was observed toward less grip strength at six months (71% [of that on the contralateral side] compared with 79%; mean difference, –8% [95% confidence interval = –15.3% to –0.6%]; p = 0.03) and less flexion (54° compared with 59°; mean difference, –5° [95% confidence interval = –11.7° to –0.8°]; p = 0.02) and ulnar deviation (32° compared with 36°; mean difference, –4° [95% confidence interval = –7° to –0.1°]; p = 0.05) at twenty-four months after surgery in patients with an untreated fracture of the ulnar styloid base. There were no significant differences with regard to any tested outcome measure between the patients with ≥2 mm of displacement of an unrepaired fracture of the ulnar styloid base and those with less displacement.

Conclusions: An unrepaired fracture of the base of the ulnar styloid does not appear to influence function or outcome after treatment of a distal radial fracture with plate-and-screw fixation, even when the ulnar fracture was initially displaced ≥2 mm.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.


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J. K. Kim, Y.-D. Koh, and N.-H. Do
Should an Ulnar Styloid Fracture Be Fixed Following Volar Plate Fixation of a Distal Radial Fracture?
J. Bone Joint Surg. Am., January 1, 2010; 92(1): 1 - 6.
[Abstract] [Full Text] [PDF]

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Effect of Ulnar Styloid Injury on Outcome Following Fixation of Distal Radial Fractures
Omar Al-Fakayh
JBJS Online, 11 Sep 2009 [Full text]
Dr. Ring and colleagues respond to Mr. Al-Fakayh
David Ring, MD, PhD, et al.
JBJS Online, 11 Sep 2009 [Full text]