Sanj kakar, md, faoa, rochester, mn demonstrates the ulna styloid plate which provides a low profile repair with many design features to anatomically reduce and stabilize a variety of fracture patterns. Ulnar and radial shaft fractures musculoskeletal medicine. More than half of distal radius fractures are combined with an ulnar styloid fracture, and considerable cases of ulnar styloid fractures result in nonunion. The scope of this guideline is specifically limited to acute distal radius fractures. D istal ulna fractures are relatively uncommon in isolation, but they are frequently associated with distal radius fractures in the form of ulnar styloid fractures. The majority of distal radius fractures are associated with an ulnar styloid fracture. More than 40% range 2161% of distal radius fractures have an associated ulnar styloid fracture 11. Scaphoid fracture commonly caused by a foosh as well. An accompanying ulnar styloid nonunion in patients with distal radius malunion has no apparent adverse effect on outcome or function after corrective radial osteotomy.
Sep 03, 2008 others have found no difference when comparing the overall functional results with or without an ulnar styloid fracture 23, 24. The management of distal ulnar fractures in adults. Fractures of the distal ulna often accompany frac tures of the distal radius. The management of acute ulnar styloid fractures is based on the longterm effect that they may have on the stability of the distal radioulnar dru joint. Ignore fractures of the ulnar styloid in distal radius. Monteggia fracture of the proximal ulna with anterior dislocation of the. When distal ulna fractures are isolated, direct trauma causing the socalled nightstick fracture, occurring from a focal blow against the soft tissuedeficient ulnar border, is the prevailing mechanism. The role of surgical fixation of ulnar styloid fractures remains a subject of debate. Ulnar styloid fracture irrespective of dru joint instability. Each requires individual assessment and management, but general principles can be applied. Clinical assessment of druj stability after radius fixation is the best determinant of whether ulnar styloid repair is indicated.
Radiographs obtained at the time of injury are shown in figure a. The purpose of this study was to evaluate the treatment results, with and without internal fixation of ulnar styloid base fractures associated with acute distal radius fractures. An uncommon case report chi kin lo and wing lok kam abstract introduction. A small avulsion fracture off the ulnar styloid arrowhead is also. If you have a wrist fracture, your doctor will likely decide your treatment based on the injury to the radius bone, if applicable, rather than the ulnar styloid fracture. An accompanying nonunion of the ulnar styloid can heal following corrective radial osteotomy. Wrist fractures often involve the ends of two bones in your forearmthe radius and the ulna. The bony part of your wrist next to your pinky finger is the end of the ulna, also known as the ulnar styloid process. Transverse fracture of the distal radial metaphysis with dorsal displacement and angulation of the carpal bones and distal fragment of the radius. Management of ulnar sided wrist pain diane coker, pt, dpt, cht management of ulnar sided wrist pain differential diagnosis osseous hamate fracture pisiform fracture ulnar styloid fracture triquetral avulsion base of 5th metacarpal. They affect your ulnar styloid process, a bony projection that helps attach your hand to your arm. Hence, fixation of a small sized ulnar styloid in the acute setting of a distal radius fracture is probably unnecessary.
Early and late fixation of ulnar styloid base fractures. There is solid evidence in the literature that this association may ultimately affect the clinical outcome causing instability, disability, and pain in the distal radioulnar joint druj 2, 47. A blow to the dorsal or ulnar wrist may fracture the tip of the ulnar styloid fig. Fractures at the base are more likely to cause instability of the distal radio ulnar joint. This is the concomitant druj injury found in most displaced distal radial. Proper diagnosis and treatment is necessary to preserve the functioning of wrist joint. The effects of ulnar styloid fractures on patients sustaining. Of the tip fractures, 33% healed, 35% of mid ulnar styloid fractures healed, and 42% of base fractures healed. The foveal attachmentjust radial to the base of the ulnar styloidis over a broad area and gives rise to nearvertical fibers. Radiographic union of the ulnar styloid was seen in 42 34% of the usfs. The meticulous histological analysis of the radioulnar ligaments by nakamura and colleagues 1 reveals two predominant attachments to the distal ulna. First and the most common cause for the fracture of the ulna fracture is a fall. The radial styloid is within the fracture fragment, although the fragment can vary markedly in size.
Management of distal ulnar fracture combined with distal. In such circumstances they can be treated with an above elbow cast for 6 weeks. Radius styloid process fractures treated with breakaway. The goal of treatment of radius styloid process fractures are not only to restore the articular congruity of the end of the radius but also to restore the length, alignment and integrity of the supporting volar capsular ligaments of the wrist 1. The term is classically used to describe a fracture through the distal metaphysis approximately 4. The treatment of choice for distal radius fractures in the 1980s has fallen out of favor. Apr 04, 2018 approximately 60% of ulnar styloid fractures also have an associated fracture of the ulnar neck. Fractures of the distal ulna associated with fracture of the. Fixing fractures of the ulnar styloid in distal radius fractures ncbi. Pdf the management of distal ulnar fractures in adults. Acute, traumatic d radial avulsion sigmoid notch fracture a tfcc wear b tfcc wear with lunate andor ulnar head chondromalacia c tfcc perforation with lunate andor ulnar head chondromalacia d tfcc perforation with lunate andor ulnar head chondromalacia, and. Should an ulnar styloid fracture be fixed following.
Isolated ulnar styloid fractures are mostly benign and are treated by nonoperative means. There is solid evidence in the literature that this association may ultimately affect the clinical outcome causing instability, disability, and pain in the distal radioulnar joint druj 2,47. Only a handful of articles have reported surgical management and outcomes of ulnar styloid fractures 1, 12,19. Isolated fracture of the ulna nonoperative management. There is solid evidence in the literature that this association may ultimately affect the clinical. Treatment of associated ulnar styloid fracture has been addressed,24 but lim.
The ulnar styloid fracture rarely needs specific treatment. Ulnar styloid fracture is common in children and young adults involved in impact activities and in elderly people who are at an increased risk of falls and osteoporosis. A number of associated injuries are frequently encountered and may significantly impact on management. Chauffeur fractures also known as hutchinson fractures or backfire fractures are intraarticular fractures of the radial styloid process. Ulnar styloid fractures with disruption of the triangular fibrocartilage complex require repair to maintain distal radioulnar joint stability.
Fractures of the distal ulna associated with fracture of. Best practice for management of distal radial fractures drfs the british orthopaedic association boa and the british society for surgery of the hand bssh have collaborated to commission a committee to produce best practice guidelines on the management of distal radial fractures drfs. May 07, 2018 additionally, osteoporosis increases the risk for the fracture. What is ulnar styloid fracture symptoms, causes and treatment. The purpose of this study was to discuss the presentation in a case series of ulnar styloid fractures and to compare the treatment outcomes.
A fracture of the distal portion of the radius bone. The term is classically used to describe a fracture through the distal metaphysis approximately 4 cm proximal to the articular surface of the radius. Fixation of distal ulnar fracture can be achieved by kirschner wire, blade plate, and lag screws supplement with tension band wiring. The treatment of distal radius fractures summary of recommendations the following is a summary of the recommendations in the aaos clinical practice guideline, the treatment of distal radius fractures. Feb 16, 2011 a single surgeon operated on 120 adult patients with an unstable fracture of the distal radius with a fracture at the base of ulnar styloid between 2000 and 2007. For the purposes of this investigation a fracture of the ulnar styloid base was defined as a fracture at least 50% of the total height on the posteroanterior radiograph of the wrist. However, the main complaint is typically localised pain and tenderness over the anatomical snuffbox triangular depression over lateral, dorsal hand. Common forearm fractures in adults american family physician. It often causes pain, swelling and difficulty in movement. It is important to know the causes, symptoms, treatment and rehabilitation of ulnar styloid. Ulnar styloid fracture is a common occurrence, especially when a person falls on an outstretched hand. Orbay and others published ulnar head and styloid fractures find, read and cite all the research you need on researchgate.
Pediatric distal forearm and wrist injury rsna publications online. May 19, 2015 fractures of the ulnar styloid frequently accompany fractures of the distal radius, however, there is no conclusive evidence whether it influences the final outcome of the treatment. Fractures of the distal ulna associated with fracture of the distal radius. We will look at fractures common to everyday primary care visits to help you become more. Unfortunately, there are limited level1 studies to guide the management of isolated ulnar shaft fractures. Only a few case series that look into the management of ulnar fracture nonunion have been reported in the literature. Fractures of the distal radius wrist fractures geeky medics. Isolated fractures of the articular portion of the distal ulna are rare and should be treated operatively only if irreducible articular displacement causes a mechanical block to forearm rotation. Usually, this kind of fracture occurs as the result of a fall on an. More than 40% range 2161% of distal radius fractures.
Displaced fractures of the ulnar styloid base associated with a distal radius fracture result in instability of the druj and resulting loss of forearm rotation. Isolated ulnar shaft fractures, although seemingly benign, may be complicated by nonunion, radioulnar synostosis, and loss of motion. Early and late fixation of ulnar styloid base fractures yields different. In the usf group, 64 45% had fractures at the tip, 32 23% in the middle, and 46 32% at the base of the ulnar styloid. Suggested by local tenderness over the styloid process. A radial shaft fracture with distal radial ulnar joint druj instability is known by its eponym, the galeazzi fracture. Significance of ulnar styloid fractures in childhood. The purpose of this study was to compare the surgical outcomes following early and late intervention. Will the untreated ulnar styloid fracture influence the outcome of. Initial management of forearm fractures should follow the price. We emphasize that ulnar styloid fractures have to be assessed not solely as a bony fracture, but as a possible destabilizing injury to the ulnoradial ligament. Evans, rb, 2015 1 therapeutic management for distal radius fractures. Our retrospective study of 222 children with wrist fractures showed that ulnar styloid fractures seldom occur as isolated injuries.
Should an ulnar styloid fracture be fixed following volar plate fixation of a distal radial fracture. Ulnar avulsion ulnar styloid fracture c distal avulsion from carpus i. It is present at the end of the forearm and commonly known as the ulna. Ulnar styloid fracture radiology reference article. Fixation of ulnar styloid fractures associated with distal radius. Pdf fixing fractures of the ulnar styloid in distal radius. Ulnar styloid and ulnar headneck fractures are likewise described. Distal radius fractures a clinical casebook jeffrey n. Usually, radius styloid process fractures without displacement are treated with immobilization.
May 19, 2015 the majority of distal radius fractures are associated with an ulnar styloid fracture. In children, fractures of the distal radius often can be subtle. Classification and treatment of ulnar styloid nonunion. Fracture nonunions of the hamate 14, pisiform510, triquetrum 11, base of the fifth metacarpal 1417, ulnar styloid process, and distal part of the ulna or radius have been reported to cause ulnar sided wrist pain. Galleazzi fractures always require plate fixation of the radius distal medullary canal too widefunnel shaped for intramedullary fixation sometimes require temporary pin fixation of druj or repair of the ulnar styloid when fractured postop.
A current prospective study reported symptomatic nonunion that was successfully. Isolated distal ulnar fracture is an uncommon injury. Fracture nonunions of the hamate 14, pisiform510, triquetrum 11, base of the fifth metacarpal 1417, ulnar styloid process, and distal part of the ulna or radius have been reported to cause ulnar. In spite of acting as a unique strut on the ulnar end to stabilize the ulnar soft tissue and maintain the congruency of the distal radioulnar joint druj, the majority of these connected tissues including the triangular fibrocartilage complex tfcc are at the base. Only a few case series that look into the management of ulnar fracture nonunion have been reported in the. Six consecutive patients underwent resection of the nonunion and plate osteosynthesis with a 2. Apr 12, 2018 ulnar styloid fractures often accompany a radius fracture. Fracture at base of ulnar styloid widened druj on ap xray subluxed ulna on lateral xray 5 mm radial shortening radius fracture jul 31, 2018 an ulnar styloid fracture is common and may be associated with a distal radial fracture drf or occurs as an isolated injury. Nerve injury, especially of the median nerve and presenting as carpal tunnel syndrome, is commonly reported following distal radius fractures. Therapeutic management for distal radius fractures. Ulnar styloid fractures often occur in association with distal radial fractures. The treatment is aimed on allowing the bones to heal back into their original position.
Ulnar styloid fracturetreatmentexerciserehabcauses. However, ulnar styloid nonunion usually does not cause any problems on the wrist. Ulnar styloid fractures seldom require treatment when they occur in association with a distal radius fracture. We report a case of isolated distal ulnar fracture that was treated with open reduction and fixation with locking plate which subsequently developed fracture nonunion.
The majority of studies show no negative effect of ulnar styloid fractures on final outcome, when the fracture of the distal radius is fixed, preferably by a. Disorders of the distal radioulnar joint druj are a common source of ulnar sided wrist pain. Treatment of symptomatic nonunions of the base of the ulnar. Similarly, fractures of the ulnar styloid process, seen more frequently, can on occasion produce secondary instability of either the ulnocarpal joint or the druj if left untreated. Please fax initial evaluation and progress notes to 815. The ulnar styloid fractures extend from the distal tip to the fractures at the base of the styloid. Acute triangular fibrocartilage complex tfcc injuries can occur after a fall onto an outstretched. Ulnar styloid fractures occur in association with 60% of distal radius fractures.
Healing of an ulnar styloid fracture can be done best through exercise. Distal radius fracture orif rehabilitation protocol kelly holtkamp, m. Colles fracture is the most common extension fracture pattern. Condylar blade plate fixation of unstable fractures of the distal. Dec 11, 2017 ulnar styloid fracture is a common occurrence, especially when a person falls on an outstretched hand. Based on the published literature to date acute ulnar styloid fractures can be managed in the following ways. Fracture of the ulnar styloid may be associated with a distal radius fracture. Nov 15, 2009 initial fracture management generally follows the traditional price protection, rest, ice, compression, and elevation protocol. Cases included illustrate the various uses of the volar locking plate for metaphyseal and periarticular fractures, among others, as well as management strategies for open reduction internal fixation orif for the radial styloid.
The indications for ulnar styloid fixation are incompletely defined. The ulnar side of the wrist has often been likened to the lower back because of the difficulties involved in establishing a specific diagnosis for pain at both sites and therefore in. The ulnar styloid may be fractured in an injury to the wrist. A fractured ulnar styloid process may not be easily apparent on xray if there is no displacement. Ulnar styloid fractures make up a common component of wrist fractures. When you break that part of the wrist, its called an ulnar styloid fracture. Ulnar styloid fractures often accompany a radius fracture. Degenerative processes at the pisotriquetral joint 18, midcarpal triquetrohamate articulation, fifth. Approximately 60% of ulnar styloid fractures also have an associated fracture of the ulnar neck. With only the tip of the styloid fractured, the tfcc will remain intact, since its major. Isolated ulnar fractures can usually be managed with a short arm cast or a functional forearm brace. The purpose of this prospective case series was to assess the efficacy of plate osteosynthesis using a low profile distal ulna plate for the management of persistently symptomatic nonunions of the base of the ulnar styloid. A patient with a galeazzi fracture will present not only with pain in the forearm where the radius is broken, but also swelling, tenderness, and pain at the wrist where there is a dislocation of the distal radioulnar joint. The influence of nonunion of the ulnar styloid on pain.
Ulnar shaft fractures are commonly a result of direct trauma, as in the termed nightstick injury, which involves a distal twothird shaft fracture of the ulna. Ulnar styloid fracture fracture of the ulnar styloid may be associated with distal radius fractures. These injuries can also be seen in cases of physical abuse and should provoke at least consideration of abuse as the inciting cause. Distal radius fracture orif rehabilitation protocol. The head is separated from the styloid process by a depression for the attachment of the apex of the triangular articular disk, and behind, by a shallow groove for the tendon of the extensor carpi ulnaris muscle. The ulnar styloid fracture may be distal to the true stabilising insertion at the fovea and does not affect the stabilizing properties of the ulnoradial ligament.
It is not necessary to actively treat all fractures of the distal ulna. Most of these are small avulsion fractures involving the tip of the ulnar styloid. Fixing fractures of the ulnar styloid in distal radius. The unstable distal radius fracture drf is a common injury that requires operative treatment 1, 2. Evans, otrl, cht march 8, 2015 drf is the most common fx in human skeleton, comprising 18% of all fractures and affecting an estimated 85,000 medicare beneficiaries each year.
Current concepts in the management of distal radius fractures gregory rafijah, m. Aug 12, 2015 a minimally displaced or undisplaced ulnar styloid fracture or a styloid fracture that reduces with the reduction of the distal radius can be placed in a long arm cast in a midhorizontal position for about three to four weeks. The splinter series is back with its fourth installment. If the ulnar styloid fracture is associated with a distal radius fracture, the ulnar styloid fracture will reduce with reduction of the distal radius in many cases fig. For a mild ulnar styloid fracture, it often requires a basic wrist cast.1363 349 1286 813 843 19 1018 128 407 317 173 1135 1313 1489 1442 1320 440 1026 1117 1222 1423 1475 1014 226 464 169 1429 760 957 924 362 224 266