Presence of an Associated, Untreated Ulnar Styloid Fracture, Adversely Affect the Outcome in Distal Radius Fracture: A Paradigm Worth Pondering

Vol. 9 | Issue 1 | January-February 2021 | Page: 41-48 | Rraghavendra. S. Kulkarni, Rachana A. Kulkarni, Ranjani R. Kulkarni, R. S. Deshpande, SriRam R. Kulkarni

Authors: Rraghavendra. S. Kulkarni [1], Rachana A. Kulkarni [2], Ranjani R. Kulkarni [3], R. S. Deshpande [4], SriRam R. Kulkarni [5]

[1] Medical Superintendent, SSPM Medical College & LT Hospital, Padve, Sindhudurg, Maharashtra, India.
[2] Jawaharlal Nehru Medical College, Belgavi, Karnataka, India.
[3] Medical Officer, Govt. Polyclinic, Oros, Sindhudurg, Maharashtra, India.
[4] Department of Anaesthesiology, SSPM Medical College & LT Hospital, Padve, Sindhudurg, Maharashtra, India.
[5] Govt. Medical College Miraj & Civil Hospital Sangli, Maharashtra, India.

Address of Correspondence
Dr. Raghavendra S. Kulkarni
HOD Bungalow No. 6, SSPM Medical College & Lifetime Hospital, Padve, Sindhudurg, Maharashtra, India.
E-mail: rskulkarnics53@gmail.com

Abstract

Background: Yet the unresolved question of the relationship between concomitant ulnar styloid fracture and the final outcome of distal radius fracture needs further evaluation.
Methods: This study was carried out for 4672 patients of fracture distal radius, recruited in an ongoing longitudinal study to evaluate the radiological and functional outcomes treated by one surgeon at Government Hospital institute between 1986 to 2011. The right wrist was injured in 2986 (63.9%). There were 3236(69.3%) men and 1436(30.7%) women, with a mean age of 59 years (range 8 to 98 years). In intact styloid group, 1948(72.8 %) were men and 726(27.2%) women, in fractured styloid group 1386(69.4%) were men & 612(30.6%) women.
Results: 2674 (57.2%) patients had intact ulnar styloid and 1998 (42.8%) distal radius fracture with concomitant ulnar styloid fracture. This was again divided into two groups: 1426 (71.4%) had an ulnar styloid base fracture and 572 (28.6%) belong to the ulnar styloid tip fracture group.
224(8.4%) patients with intact styloid and 346(17.3%) with ulnar styloid fracture presented with ulnar side wrist pain. 264(9.9%) had acute or chronic distal radioulnar joint instability with intact styloid, as compared to 746(37.3%) with ulnar styloid fracture group. The mean volar tilt was 11.90(60 to 180) in the intact styloid and 12.60(70 to 190) in the fracture styloid group. The respective values for the base and tip group were 11.60(50 to 170), 12.40(60 to 180) at final follow-up. The mean ulnar variance was observed – 0.4 to 0.6 in the intact styloid group and 0.2 to 0.4 in the fracture styloid group at the final follow-up (p < 0.0001). The grip strength was 92.2% in the intact styloid group and 82.4% in the fracture ulnar styloid group. The hand performance was rated as excellent in 1020 (38.1%), good 1318 (49.3%), fair 204(7.6%), poor 132 (4.9%) in intact styloid group as compared to fracture ulnar styloid group, excellent 582 (29.1%), good 684 (34.2%), fair 513 (25.7%) and poor in 219 (10.9%).
Conclusion: This large sample series report concludes a very distinctly unsatisfactory final outcome uniformly, in fracture ulnar styloid group of distal radius fractures, even in spite of adequate treatment by five different modalities of treatment, which were compared very rigorously. The great influence of ulnar styloid fracture in distal radius fracture is once again well established and this study reinforced categorically the previously published articles by the same author in the past.
Keywords: Distal radius fracture; Ulnar styloid fracture outcome; Ulnar wrist pain; Distal radioulnar joint instability.

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