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Background: Ulnar styloid fractures (USFs) are common concomitant injuries associated with distal radius fractures (DRFs). Recent studies have found conflicting evidence on whether these fractures treated or untreated effect pain and functional outcomes. The purpose of this study was to prospectively evaluate pain and function outcomes of consecutively untreated USFs in surgically repaired DRFs. The study hypothesis was that there would be no difference in outcomes whether an USF is present or not, with all cases left untreated. Methods: A prospective study at a single institution of consecutive DRF treated surgically with volar locked plating was undertaken. No patients underwent fixation of an USF if present. There were no treated USF that were excluded. Patients with associated ulnar neck and shaft fractures were excluded. Functional outcome measures were analyzed using the Quick Disabilities of the Arm, Shoulder, and Hand score (QDASH) and the Patient-Rated Wrist Evaluation (PRWE) scores. Outcome measures were collected at 3 months and 1 year postoperatively. Results: There was an incidence of 52.2% (n = 70/134) USF associated with surgically treated DRF. By location, there were 52.9% (n = 37/70) ulnar styloid tip fractures and 46.1% (33/70) ulnar styloid base. There were 75.7% of USF (53/70) still not healed by 1-year follow-up. When comparing patients with a DRF without an USF versus DRF with an associated USF at 12 months, there was no statistical difference in the QDASH score (6.7 vs 8.4, P = .47) or the PRWE total score (4.8 vs 7.5, P = .24). Similarly, subgroup analysis showed no statistical difference in QDASH or PRWE scores at final follow-up in united USF versus nonunited USF subjects (QDASH 14.2 vs 6.8, P = .112; PRWE 14.8 vs 5.4, P = .185). Conclusions: USFs are a common concomitant injury occurring in nearly half of DRFs treated surgically. Our prospective cohort analysis showed that neither the presence, type, nor bony union status of a concomitant USF has any significant effect on patient outcomes or reoperations at 1-year postoperatively. Our study confirms our hypothesis that USF of the tip and base should be left untreated.

Background: Fractures of the radial shaft with disruption of the distal radial ulnar joint (DRUJ) or Galeazzi fractures are treated with reduction of the radius followed by stability assessment of the DRUJ. In rare instances, the reduction of the DRUJ is blocked by interposed structures requiring open reduction of this joint. The purpose of this study is to review all cases of irreducible Galeazzi fracture-dislocations reported in the literature to offer guidelines in the diagnosis and management of this rare injury. Methods: A search of the MEDLINE database, OVID database, and PubMed database was employed using the terms “Galeazzi” and “fracture.” Of the 124 articles the search produced, a total of 12 articles and 17 cases of irreducible Galeazzi fracture-dislocations were found. Results: The age range was 16 to 64 years (mean = 25 years). A high-energy mechanism of injury was the root cause in all cases. More than half of the irreducible DRUJ dislocations were not identified intraoperatively. In a dorsally dislocated DRUJ, a block to reduction in most cases (92.3%) was secondary to entrapment of one or more extensor tendons including the extensor carpi ulnaris, extensor digiti minimi, and extensor digitorum communis, with the remaining cases blocked by fracture fragments. Irreducible volar dislocations due to entrapment of the ulnar head occurred in 17.6% of cases with no tendon entrapment noted. Conclusions: In the presence of a Galeazzi fracture, a reduced/stable DRUJ needs to be critically assessed as more than half of irreducible DRUJs in a Galeazzi fracture-dislocation were missed either pre- or intraoperatively.

Background: The deep portion of the distal radioulnar ligaments (DRUL) inserts on the ulnar fovea and is the most important stabilizer of the distal radioulnar joint (DRUJ). Ulnar styloid base fractures that include the ulnar fovea may cause DRUJ instability. Methods: DRUJ stability in pronosupination was evaluated in 12 fresh-frozen upper extremities (4 female) aged 52 to 68 years (mean: 58.8 years) using a custom fixture, which allowed free rotation of the radius around the fixed ulna. Optical motion capture was used to record rotation of the radius with respect to the ulna. Each specimen was subjected to 3 N m of torque in both supination and pronation under 4 conditions: intact, ulnar styloid osteotomy with disruption of the foveal insertion of the DRUL, ulnar styloid fixation, and DRUL transection. Group differences were compared using a 1-way repeated-measures analysis of variance and Tukey multiple comparison post hoc tests. Results: When compared with the intact condition, both ulnar styloid osteotomy and DRUL transection significantly increased mean pronation (by 9.40° and 15.21°, respectively) and supination (by 9.05° and 17.42°, respectively) of the forearm. Screw fixation only significantly reduced pronation compared with osteotomy (by 2.62°). Screw fixation did not significantly affect supination. Conclusions: Ulnar styloid fractures that disrupt the fovea cause instability of the DRUJ in pronation and supination under 3 N m of torque in a cadaveric model. Screw fixation of ulnar styloid base fractures achieves anatomic reduction; however, it only partially returns rotational stability acutely to the DRUJ and only during pronation.

Purpose: There remains uncertain whether to fix an ulnar styloid fracture accompanied by distal radius fracture. Fixation should be required in cases of the fracture involving a fovea of ulnar head, an attachment site of deep portion of triangular fibrocartilage. We analyzed the patients with ulnar styloid fracture accompanied by distal radius fracture using simple radiograph and 3D computed tomography (3D CT) scan images, respectively, and compared accuracy of evaluation for the types of ulnar styloid fractures, which might designate the treatment methods. Materials and Methods: We retrospectively reviewed 168 patients who underwent surgery for distal radius fracture in our hospital from January 2005 to March 2015, and evaluated whether ulnar styloid base was involved using simple radiographs and 3D CT scan images. The accuracy of evaluation by simple radiographs was compared with the findings of 3D CT scan images. To avoid the effect of memory, evaluation using 3D CT scan images was performed in a randomized order 2 weeks after initial evaluation for simple radiograph. Results: On simple radiographs, 64 patients (38%) had ulnar styloid base fractures; however, 21 cases of these revealed nonbase fractures by 3D CT scan images. And 7 out of 104 cases, on simple radiographs, determined as nonbase fracture by simple radiographs, were diagnosed as base fractures by 3D CT scans. Based on the findings of 3D CT scan images, the accuracy of simple radiographic evaluation for types of ulnar styloid fractures was 83%, with 86% sensitivity and 82% specificity. The positive predictive value was 67% and the negative predictive value was 93%. Conclusion: Accuracy of radiographic evaluation of ulnar styloid base fracture accompanied by distal radius fracture, when compared with 3D CT, was 83%. Therefore, we recommend that 3D CT scan image–based evaluation should be performed in case of unclear involvement sites so as to determine whether to fix it or not.

Background: Insertion of the distal radioulnar ligaments onto the distal ulna is critical to provide translational stability and rotational guidance of the forearm. However, the topographic anatomy of the footprints of these ligaments and their relationships with morphometry of the distal ulna remain unclear. Purpose: We provide a detailed description of the anatomy and the relationships described above in a cadaveric study. Methods: Seventeen human distal ulnas attached by both the superficial and deep limbs of the distal radioulnar ligaments were scanned using micro-computed tomography and reconstructed 3 dimensionally. Results: The deep limbs have narrow marginal insertions just behind the pole of the distal ulna, but the width of the footprint was larger at the fovea than at the peripheral lesion. The superficial limb footprints were the circular and condensed shape. The center of the deep limb was radially distant from the base of the ulnar styloid by a mean of 2.00 ± 0.72 mm, and the distance was positively correlated with the width of the ulnar styloid ( r = .517, P = .030). The mean distance between the center of the ulnar head and the center of the fovea was 2.34 ± 0.62 mm. Conclusions: The deep limb has a narrow marginal insertion just behind the pole of the distal ulna, suggesting its role as the capsular ligament. The center of the fovea is located more radially from the ulnar styloid base. The data provide a better understanding of distal radioulnar ligament-related pathology to perform distal ulnar fixation or ligament repair to recover distal radioulnar joint stability.

Objective: The objective of this study was to compare surgical versus nonsurgical treatment of ulnar styloid fractures occurring in the context of distal radius fractures treated by open reduction and internal fixation (ORIF) with volar locked plates. Methods: A multicenter retrospective study, including four different level I trauma centers, was carried out. Patients operated on between 2009 and 2012, with ulnar styloid fractures, in the context of an unstable displaced distal radius fracture that had ORIF with a volar locked plate were included; they were divided into two groups according to whether the ulnar styloid fracture was treated nonsurgically (group I) or surgically (group II). Only patients in which distal radius fracture reduction after ORIF was considered anatomical were included. Ulnar styloid fractures were classified according to Rotella’s classification. Results: Fifty-seven patients were included in the study (group I: 29, group II: 28). Follow-up averaged 55.98 months and was different between groups (group I: 63.14 months SD, 1.95, and group II: 48.43 months SD, 3.74), averaging 14.5 months (SD, 4.5) less in group II ( P = .001). Patient’s age averaged 49.5 years (SD, 1.82) and was similar ( P = .225) between both groups. Women were more frequent in group II ( P = .0435). In 35% of patients, the dominant extremity was operated; dominance was different ( P = .0501) between groups (28% in group I and 42% in group II). According to Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification in group I, there were 10 type A, 1 type B, and 18 type C fractures, whereas in group II, there were 7 type A, 5 type B, and 16 type C fractures. Ulnar styloid fractures were located at its base in 28 patients, middle third in 19 patients, and tip in 10 patients. Ulnar styloid classification distribution evidenced differences between groups ( P = .020); while in group I, there was homogeneous frequency of proximal and tip fractures, and most fractures in group II were proximal. Styloid fracture union chance was statistically significantly different ( P = .054; styloid fracture united in 14 of the 29 cases of group I and in 19 of the 28 cases of group II); patients in group II had 2.76 (95% confidence interval [CI], 1.086-8.80) more chances of uniting than those in group I. Disability of the Arm, Shoulder and Hand (DASH) score and Visual Analog Scale (VAS) pain score (at rest and during activities) did not show significant differences between groups (DASH, P = .276; VAS at rest, P = .877; and VAS during activities, P = .681). Ulnar deviation and strength at last follow-up evidenced better results in group I ( P = .0389 and P = .024, respectively). Postoperative immobilization, performed using long-arm or short-arm, casts or braces, was different in the groups ( P < .001); 41% of patients in group I had a long-arm cast and the rest a short-arm brace, whereas 95% of patients in group II had braces. There were no significant differences in time of postoperative immobilization ( P = .469). Conclusion: In this multicenter study, no significant differences between surgical and nonsurgical treatment of ulnar styloid fractures occurring in the context of distal radius fractures treated by ORIF with volar locked plates were evidenced. Anatomical reduction of distal radius fractures remains the most important objective in treating these lesions.