Impact of ulnar styloid fractures in nonoperatively treated distal radius fractures
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ORIGINAL ARTICLE
Impact of ulnar styloid fractures in nonoperatively treated distal radius fractures M. K. van Valburg • M. M. E. Wijffels P. Krijnen • I. B. Schipper
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Received: 21 August 2012 / Accepted: 10 January 2013 / Published online: 26 February 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose The effect of an ulnar styloid fracture (USF) on the stability of nonoperatively treated distal radius fractures (DRF) is unknown. The aim of this study was to evaluate the influence of USFs on the dislocation of DRFs treated by closed reduction. Methods Standardized radiographs of 100 nonoperatively treated DRFs were evaluated. DRFs with a USF were compared to DRFs without a USF with respect to dorsal tilt, radial inclination, and ulnar variance. Results We evaluated the radiographs of 100 DRFs in 99 consecutive patients, of whom 84 were women. An accompanying USF was present in 58 wrists, of which 49 were displaced. On the trauma radiograph, the USF group showed significantly more overall dislocation. After closed reduction, fracture position improved, and no significant differences in dislocation were observed between groups. After a mean of 42 days, radial inclination significantly decreased if a USF was present. When USF displacement was taken into account, significantly more ulnar variance occurred in the displaced USF group on the trauma and follow-up radiograph compared to the nondisplaced USF group and no-USF group. Conclusions The results of this study show that presence of a dislocated USF in patients with a DRF is associated with a worse position directly after trauma, and with recurrence of radial shortening after adequate reduction. These results warrant early radiologic follow-up in patients
M. K. van Valburg M. M. E. Wijffels (&) P. Krijnen I. B. Schipper Department of Surgery, Traumatology, Leiden University Medical Center, K6-50, P.O. Box 9600, 2300 RC Leiden, The Netherlands e-mail: [email protected]; [email protected]
with reduced combined DRFs and USFs in order to evaluate the redislocation of the distal radius. Early detection of redislocation in these combined fractures may induce early surgical intervention. Keywords Distal radius fracture Ulnar styloid fracture Fracture stability Dislocation Nonoperative treatment
Introduction One in six patients who present with a fracture at the emergency department has a distal radius fracture (DRF) [1–3]. Of those patients, 44–65 % also have an ulnar styloid fracture (USF) [4–7]. Since the triangular fibrocartilage complex (TFCC) inserts on the base of the ulnar styloid [3, 8–10], distal radioulnar (DRU) joint instability may result when a USF is present, due to TFCC disruption [11–16]. In only minimally dislocated DRFs, nonoperative treatment leads to a satisfactory anatomical end result [17], since the functional outcome of the DRF depends on restoration of the anatomy [18–20]. Several radiographic parameters may have prognostic value for the outcome of DRF treatment [21, 22]. Radial inclination could be useful
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