Subscribe to RSS
DOI: 10.1055/s-0037-1607214
Effects of Ulnar Styloid Fractures on Unstable Distal Radius Fracture Outcomes: A Systematic Review of Comparative Studies
Publication History
12 June 2017
05 September 2017
Publication Date:
11 October 2017 (online)
![](https://www.thieme-connect.de/media/jws/201802/lookinside/thumbnails/10-1055-s-0037-1607214_1700046-1.jpg)
Abstract
Purpose In this literature review, functional outcomes such as Disability of Arm, Shoulder and Hand (DASH) score and the visual analog scale (VAS) of pain along with clinical outcomes such as range of movement and grip strength of treated distal radius fractures (DRF) accompanied with ulnar styloid fractures (USF) will be compared with those with isolated DRF.
Materials and Methods We analyzed articles from MEDLINE, Embase, and CINAHL that met our predetermined inclusion and exclusion criteria as per the Preferred Reporting Items for Systematic Reviews and Meta-analysis statements. This resulted in the identification of 464 articles with 18 potentially eligible studies of which 6 were included at the full-text screening stage. The primary outcomes were wrist pain, range of motion, functional outcome and satisfaction, such as VAS, and the DASH questionnaire along with radiological assessment and incidence of complications.
Results These studies involved 796 participants with DRF and 806 wrists with DRF; 444 (55%) of DRF had an associated USF. Three studies did not report any statistically significant difference in DASH scores between the DRF patients with or without USF. Two studies reported worse DASH scores in the group with associated USF. Wrist pain was reported to be statistically significantly worse in patients with associated USF in two studies. Grip strength did not exhibit a statistically significant difference in any groups in four studies. On assessing the range of motion of the wrist and forearm, only one study reported a statistically significant difference in flexion at 2 years follow-up, with less flexion in patients with USF.
Conclusion This review suggests that there is no significant correlation between a USF and the functional and clinical outcomes of DRF treatment, albeit wrist pain and less flexion were reported in some studies to be associated with USF. There is a need for more robust evidence from large randomized controlled trials to specifically look at the effects of fixation versus nonfixation of USF on DRF, or large prospective cohort studies assessing DRF with and without USF, with a minimum of 12 months follow-up.
Level of Evidence Level II—therapeutic.
-
References
- 1 Solgaard S, Petersen VS. Epidemiology of distal radius fractures. Acta Orthop Scand 1985; 56 (05) 391-393
- 2 O'Neill TW, Cooper C, Finn JD. , et al; UK Colles' Fracture Study Group. Incidence of distal forearm fracture in British men and women. Osteoporos Int 2001; 12 (07) 555-558
- 3 Rozental TD, Branas CC, Bozentka DJ, Beredjiklian PK. Survival among elderly patients after fractures of the distal radius. J Hand Surg Am 2002; 27 (06) 948-952
- 4 Bacorn RW, Kurtzke JF. Colles' fracture; a study of two thousand cases from the New York State Workmen's Compensation Board. J Bone Joint Surg Am 1953; 35-A (03) 643-658
- 5 Frykman G. Fracture of the distal radius including sequela: shoulder-hand-finger syndrome, disturbance in the distal radioulnar joint and impairment of nerve function. Acta Orthop Scand 1967; 38: 108
- 6 Reeves B. Excision of the ulnar styloid fragment after Colles' fracture. Int Surg 1966; 45 (01) 46-52
- 7 Wysocki RW, Ruch DS. Ulnar styloid fracture with distal radius fracture. J Hand Surg Am 2012; 37 (03) 568-569
- 8 Fernandez D. Fractures of distal radius: operative treatment. In: Heckman JD. , ed. Instructional Course Lectures. Park City: American Academy of Orthopaedic Surgeons; 1993: 73-88
- 9 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 (06) 965-971
- 10 Ruch DS, Lumsden BC, Papadonikolakis A. Distal radius fractures: a comparison of tension band wiring versus ulnar outrigger external fixation for the management of distal radioulnar instability. J Hand Surg Am 2005; 30 (05) 969-977
- 11 McQueen M, Caspers J. Colles fracture: does the anatomical result affect the final function?. J Bone Joint Surg Br 1988; 70 (04) 649-651
- 12 Tsukazaki T, Iwasaki K. Ulnar wrist pain after Colles' fracture. 109 fractures followed for 4 years. Acta Orthop Scand 1993; 64 (04) 462-464
- 13 Hauck RM, Skahen III J, Palmer AK. Classification and treatment of ulnar styloid nonunion. J Hand Surg Am 1996; 21 (03) 418-422
- 14 Oskarsson GV, Aaser P, Hjall A. Do we underestimate the predictive value of the ulnar styloid affection in Colles fractures?. Arch Orthop Trauma Surg 1997; 116 (6-7): 341-344
- 15 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 (04) 371-375
- 16 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 (02) 223-227
- 17 Kim JK, Koh YD, Do NH. Should an ulnar styloid fracture be fixed following volar plate fixation of a distal radial fracture?. J Bone Joint Surg Am 2010; 92 (01) 1-6
- 18 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 Joint Surg Br 2009; 91 (01) 102-107
- 19 Krämer S, Meyer H, O'Loughlin PF, Vaske B, Krettek C, Gaulke R. The incidence of ulnocarpal complaints after distal radial fracture in relation to the fracture of the ulnar styloid. J Hand Surg Eur Vol 2013; 38 (07) 710-717
- 20 Shaw JA, Bruno A, Paul EM. Ulnar styloid fixation in the treatment of posttraumatic instability of the radioulnar joint: a biomechanical study with clinical correlation. J Hand Surg Am 1990; 15 (05) 712-720
- 21 Souer JS, Ring D, Matschke S, Audige L, Marent-Huber M, Jupiter JB. ; AOCID Prospective ORIF Distal Radius Study Group. Effect of an unrepaired fracture of the ulnar styloid base on outcome after plate-and-screw fixation of a distal radial fracture. J Bone Joint Surg Am 2009; 91 (04) 830-838
- 22 CRD University of York. Systematic Reviews CRD's (Centre for Reviews and Dissemination) guidance for undertaking reviews in health care. 2009 . Available at: http://www.york.ac.uk/inst/crd/pdf/Systematic_Reviews.pdf . Accessed November 2013
- 23 DARE. Database of Abstracts of Reviews of Effects, Centre for Reviews and Dissemintion. University of York. 2013. Available at: www.crd.york.ac.uk/CRDWeb . Accessed November 2013
- 24 Cochrane Library. Cochrane Reviews. 2013. Available at: http://onlinelibrary.wiley.com/o/cochrane/cochrane_cldare_articles_fs.html
- 25 Evidence Search U. NICE Healthcare Databases Advanced Search. 2013. Available at: www.library.nhs.uk/hdas . Accessed November 2013
- 26 Khan K, Kunz R, Kleijnen J, Antes G. Systematic Reviews to Support Evidence-Based Medicine. 2nd ed. GB: Hodder Education; 2011
- 27 US National Institutes of Health. Clinical Trials. 2013. Available at: www.clinicaltrials.gov . Accessed November 2013
- 28 World Health Organization International Clinical Trials Registry Platform. 2013. Available at: www.who.int/trialsearch . Accessed November 2013
- 29 Current Controlled Trials. 2013. Available at: www.isrctn.com . Accessed November 2013
- 30 National Institute for Health Research (NIHR). UK Clinical Research Network Study Portfolio. 2013. Available at: www.public.ukcrn.org/search . Accessed November 2013
- 31 OpenGrey, m.E.d. System for Information on Grey Literature in Europe. 2013. Available at: www.opengrey.eu . Accessed November 2013
- 32 National Technical Information Service (NTIS). National Technical Information Service, US Department of Commerce. 2013. Available at: www.ntis.gov . Accessed November 2013
- 33 The British Library. The British Library Explore the World's Knowledge. 2013. Available at: www.bl.uk . Accessed November 2013
- 34 BIOSIS Previews. Thomson Reuters Web of knowledge. BIOSIS Previews on the Thomson Reuters Web of knowledge research platform. 2013. Available at: www.thomsonreuters.com/biosis-previews . Accessed November 2013
- 35 British Society for Surgery of the Hand (BSSH). 2013. Available at: www.bssh.ac.uk . Accessed November 2013
- 36 Trip CSE. Trip database clinical search engine. 2013. Available at: www.tripdatabase.com . Accessed November 2013
- 37 Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. Ann Intern Med 2009; 151 (04) 264-269 , W64
- 38 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PRISMA Transparent Reporting of Systematic Reviews and Meta-Analyses. 2014 Available at: www.prisma-statement.org . Accessed November 2013
- 39 Lafontaine M, Hardy D, Delince P. Stability assessment of distal radius fractures. Injury 1989; 20 (04) 208-210
- 40 Nesbitt KS, Failla JM, Les C. Assessment of instability factors in adult distal radius fractures. J Hand Surg Am 2004; 29 (06) 1128-1138
- 41 Hudak PL, Amadio PC, Bombardier C. ; The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. Am J Ind Med 1996; 29 (06) 602-608
- 42 Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther 2001; 14 (02) 128-146
- 43 Westphal T, Piatek S, Schubert S, Schuschke T, Winckler S. Reliability and validity of the upper limb DASH questionnaire in patients with distal radius fractures [in German]. Z Orthop Ihre Grenzgeb 2002; 140 (04) 447-451
- 44 Orfale AG, Araújo PM, Ferraz MB, Natour J. Translation into Brazilian Portuguese, cultural adaptation and evaluation of the reliability of the Disabilities of the Arm, Shoulder and Hand Questionnaire. Braz J Med Biol Res 2005; 38 (02) 293-302
- 45 Wah JW, Wang MK, Ping CL. Construct validity of the Chinese version of the Patient-Rated Wrist Evaluation Questionnaire (PRWE-Hong Kong version). J Hand Ther 2006; 19 (01) 18-26 , quiz 27
- 46 Belloti JC, Moraes VY, Albers MB, Faloppa F, Dos Santos JB. Does an ulnar styloid fracture interfere with the results of a distal radius fracture?. J Orthop Sci 2010; 15 (02) 216-222
- 47 Chen YX, Zheng X, Shi HF. , et al. Will the untreated ulnar styloid fracture influence the outcome of unstable distal radial fracture treated with external fixation when the distal radioulnar joint is stable. BMC Musculoskelet Disord 2013; 14: 186
- 48 Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. Available at: www.cochrane-handbook.org . Accessed November 2013
- 49 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 (09) 1595-1602
- 50 af Ekenstam F, Jakobsson OP, Wadin K. Repair of the triangular ligament in Colles' fracture. No effect in a prospective randomized study. Acta Orthop Scand 1989; 60 (04) 393-396
- 51 Zenke Y, Sakai A, Oshige T, Moritani S, Nakamura T. Treatment with or without internal fixation for ulnar styloid base fractures accompanied by distal radius fractures fixed with volar locking plate. Hand Surg 2012; 17 (02) 181-190
- 52 Geissler WB, Freeland AE. Arthroscopically assisted reduction of intraarticular distal radial fractures. Clin Orthop Relat Res 1996; (327) 125-134