Does Simultaneous Fixation of Both Distal Radius and Distal Ulnar Fractures Improve Outcomes? A Retrospective Cohort Study

Abstract

Introduction: Distal metaphyseal ulnar fractures are often found in conjunction with distal radius fractures. However, there is no consensus on optimal management. The purpose of this study was to determine whether simultaneous fixation of both distal radius and distal ulnar fractures would improve outcomes. Materials and Methods: Patients treated for distal radial fractures over a 4-year period at our trauma center were identified, and their medical records were analyzed. Twenty-three patients met the inclusion criteria for this study. All radius fractures were fixed using a volar locking plate. Fourteen ulnar fractures were treated with surgical fixation, and nine were treated conservatively. Data were collected on patient demographics, mechanism of injury, whether it was a closed or open fracture, Gustilo classification, AO/OTA classification, immobilization period, follow-up period, and type of treatment. Physical findings comprising the active range of motion and grip strength and radiological findings, including the ulnar variance compared to the healthy side and bone union, were evaluated. Clinical outcomes were assessed using the quick Disabilities of the Arm, Shoulder, and Hand scores. Results: There was no significant difference between the groups in the quick Disabilities of the Arm, Shoulder, and Hand scores, but the arc of dorsi-palmar flexion was more restricted in the operative group than in the conservative group. Other results were not significantly different between the two groups. Discussion: Fixation of distal metaphyseal ulnar fractures can be challenging, and several studies have shown the validity of conservative treatments. This supports the view that if the distal radius fracture is anatomically and rigidly fixed, distal metaphyseal ulnar fractures can be successfully managed conservatively. Conclusion: Our results did not show any merit in the simultaneous fixation of both distal radius and distal ulnar fractures. Thus, needless surgery should be avoided.

A Case Series of Distal Radius and Ulna Nonunion Treated with Minimal Surgical Intervention

“…5,11 Thus, a tendency for only fixation of the distal radius is expected to be more common as the patient's age increases. 5,6,8,9 We absolutely agree with the current tendency of reasonable indications for fixation of both the ulnar and distal radius fractures, and all of our practices have been conducted according to this principle since 2010. 5,6,8,9 Interestingly, we have also encountered referred patients with somewhat complicated distal radioulnar fractures.…”

“…1,2 When surgical fixation is attempted regardless of the closed or open method for radius fractures, the necessity of surgical fixation of the ulna is still being debated. [3][4][5][6][7][8][9] Generally, an unstable distal ulna is due to two factors (malalignment and instability) as established over a few decades; thus, intraoperatively, malalignment with a greater than 10°angular deformity, 3 mm or greater shortening, and one-third displacement of the fractured plane and instability relative to one another (>50% translation) with passive forearm rotation are regarded as indications for ulna fixation after stabilization of the radius. 3,5 On the other hand, since the report of Arora et al in early 2010 about older patients, 10 conservative treatment options for distal ulna fractures have been acknowledged as reasonable options for certain subgroups in the Q modifier classification at older ages.…”

Management of Very Distal Ulna Fractures: A Systematic Review

“…1). 4–6,8,9,12,20–30 The title and abstract screening had almost perfect interreviewer agreement as the κ score was 0.88 (95% CI, 0.81–0.96) and substantial agreement after the full-text screening (0.75; 95% CI, 0.55–0.96). The average MINORS score for comparative studies was 17.8 ± 3.0, or moderate quality, and 9.6 ± 1.6 for noncomparative studies, or moderate quality (see Table , Supplemental Digital Content 2, http://links.lww.com/JOT/B958).…”

“…1). [4][5][6]8,9,12,[20][21][22][23][24][25][26][27][28][29][30] The title and abstract screening had almost perfect interreviewer agreement as the k score was 0.88 (95% CI, 0.81-0.96) and substantial agreement after the full-text screening (0.75; 95% CI, 0.55-0.96). The average MINORS score for comparative studies was 17.8 6 3.0, or moderate quality, and 9.…”

Comparison of surgical treatments for distal ulna fracture when combined with anterior locking plate fixation of distal radius in the over 70 age group

“…The treatment options for DUF associated with DRF is controversial (Glogovac et al., 2022). Previous case control studies comparing non-operative treatment with various modes of fixation for DUF when combined with anterior locking plate fixation of distal radius in elderly patients have reported no difference in functional outcomes, pain scores or grip strength (Cha et al., 2012; Kurozumi et al., 2021; Lutsky et al., 2020). These reports demonstrate the limitations of rigid internal fixation for DUF with severe osteoporosis as well as the usefulness of non-operative treatment for DUF in the elderly when associated with DRF.…”