The effects of ulna styloid fracture on the functional outcome of the wrist following concomitent distal radius fractures

Background: Distal radius fractures are the most common fractures involving the upper extremity. A reported 44-65% of these fractures occur comcomittantly with ulnar styloid fractures. Whereas distal radius fractures are treated both surgically and conservatively, almost all ulnar styloid fractures are followed up convervatively. Ulnar styloid fractures are known to be related to radioulnar instability, Traiangular fibroartilage complex(TFCC) tear and and ulnar side wrist pain However, its impact on wrist function is controversial. The purpose of this study is to ascertain the effect of ulnar styloid fractures on wrist function following distal radius treatment. Methods: 81 patients treated surgically or conservatively for an Isolated distal radius or distal radius and ipsilateral ulnar styloid fracture with atleast 1 year follow up were included in the study. The study was planned and executed retrospectively to include patients treated for distal radioulnar fracture at Dokuzelyul university teaching hospital between january 2014 to september 2018. The patients were seperated into 4 groups to include patients treated conseratively or surgically for distal radius, with or without Ulnar styloid fracture. Evaluated parameters include; Patient demographic data, radıo-ulnar parameters as determined on AP/lateral X-ray graphs, wrist ROM, Patient rated outcomes; VAS, MAYO wrist and DASH scores and Hand grip. MRI scans of patients with symptomatic ulnar side wrist pain were also evaluated. Findings: The Patients consist of 35(43.2%) male, 46(56.8%) female with an age average of 53.14(21-74). There was no significant difference between the grup in terms of age(p=0,167) and follow up time 22.01(p=0.1). Statistical difference in DASH scores (P=0.0.48) was noted among the konservatively treated groups(group 1and 4), whereas there was no difference in the surgical groups(group 2 and 3) in all parameters. The localization of ulnar styloid fracture( no fracture, tip and base fracture) reveal no difference among the groups. However, not taking into consideration the modality of treatment(conservative or surgical), subgroups without ulnar stiloid fractures reveal better results in terms of extension than those with ulna base fractures. Conclusion: In as much as a significant difference in DASH score was found among the conservative group when compare in terms of fracture or not of the ulnar styloid, the difference is negligibly small. No difference in any of the parameters was found among the surgical group. We concluded that the presence or not of ulnar styloid fracture in patients with distal radioulnar fracture does not impact ulnar side wrist pain or wrist function.