Mateusz Gładysz FESSH prep

FESSH prep Wrist trauma Outcome of styloid non union, base and displaced fractures and distal radioulnar joint instability, routine fixation versus non operative treatment, intraoperative distal radioulnar joint laxity after volar plating

Ulnar styloid fracture with distal radius fracture

Last reviewed v1.0

FESSH-081Wrist trauma●●○ intermediate

Regarding an ulnar styloid fracture that accompanies a distal radius fracture:

  1. 1.Non-union of the ulnar styloid after a distal radius fracture is associated with worse patient-reported function than styloid union.

  2. 2.A fracture through the base of the ulnar styloid, and marked displacement of the styloid fragment, increase the risk of distal radioulnar joint instability.

  3. 3.In pooled comparative data, patients whose ulnar styloid base fracture was fixed had better wrist function at 6 months than those treated without fixation.

  4. 4.Fixation of an ulnar styloid base fracture lowers the rate of styloid non-union but increases complications.

  5. 5.In a prospective series, patients with distal radioulnar joint laxity after volar plating, who were splinted for one month, had worse disability scores at one year than patients with a stable joint.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-081
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. Non-union of the ulnar styloid after a distal radius fracture is associated with worse patient-reported function than styloid union.

    False

    Wijffels and colleagues' meta-analysis of six comparative studies (365 patients) found no significant difference between united and non-united styloids in patient-reported outcome, function, grip strength, pain or distal radioulnar joint instability. Yuan and colleagues' meta-analysis (10 studies, 1403 fractures) also found no difference in outcomes between union and non-union.

    • Wijffels MME, Keizer J, Buijze GA, Zenke Y, Krijnen P, Schep NWL, et al.. Ulnar styloid process nonunion and outcome in patients with a distal radius fracture: a meta-analysis of comparative clinical trials. Injury. 2014;45(12):1889-95. PMID 25282298
    • Yuan C, Zhang H, Liu H, Gu J. Does concomitant ulnar styloid fracture and distal radius fracture portend poorer outcomes? A meta-analysis of comparative studies. Injury. 2017;48(11):2575-2581. PMID 28882374

  2. 2. A fracture through the base of the ulnar styloid, and marked displacement of the styloid fragment, increase the risk of distal radioulnar joint instability.

    True

    May and colleagues reviewed 166 distal radius fractures. More than one-third of the accompanying styloid fractures involved the base, every fracture complicated by distal radioulnar joint instability had an ulnar styloid fracture, and base location and significant displacement increased the risk of instability.

    • 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(6):965-71. PMID 12457345

  3. 3. In pooled comparative data, patients whose ulnar styloid base fracture was fixed had better wrist function at 6 months than those treated without fixation.

    False

    A 2024 meta-analysis of two randomised trials and three observational studies (336 patients) found better wrist function at 6 months in patients treated without surgery, and no difference at 12 months. The authors concluded that routine fixation is not indicated, although it may be considered in selected cases, such as persistent instability on ballottement after the radius has been fixed.

    • van Rossenberg LX, Beeres FJP, van Heijl M, Hug U, Groenwold RHH, Houwert RM, et al.. Operative versus non-operative treatment of ulnar styloid process base fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2024;50(6):2843-2854. PMID 39269646

  4. 4. Fixation of an ulnar styloid base fracture lowers the rate of styloid non-union but increases complications.

    True

    In the same meta-analysis, fewer operated patients had styloid non-union (odds ratio 0.08), but more had complications (odds ratio 14.3, with a wide confidence interval and high heterogeneity). Tension band wiring was the fixation method in the included studies.

    • van Rossenberg LX, Beeres FJP, van Heijl M, Hug U, Groenwold RHH, Houwert RM, et al.. Operative versus non-operative treatment of ulnar styloid process base fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2024;50(6):2843-2854. PMID 39269646

  5. 5. In a prospective series, patients with distal radioulnar joint laxity after volar plating, who were splinted for one month, had worse disability scores at one year than patients with a stable joint.

    False

    Kim and colleagues tested distal radioulnar joint stability after volar locking plate fixation in 84 patients. The 19 with intraoperative laxity were immobilised in a forearm splint for 1 month; at 1 year their Disabilities of the Arm, Shoulder and Hand score, wrist motion, grip strength, pain and Mayo wrist score did not differ from those of patients with a stable joint.

    • Kim JK, Yi JW, Jeon SH. The effect of acute distal radioulnar joint laxity on outcome after volar plate fixation of distal radius fractures. J Orthop Trauma. 2013;27(12):735-9. PMID 23454856