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Review
. 2024 Aug 22:55:102519.
doi: 10.1016/j.jcot.2024.102519. eCollection 2024 Aug.

Ipsilateral fractures of the ulnar styloid with distal radius fractures; to fix or not? A systematic review and meta-analysis

Prasoon Kumar  1 , Ankit Dadra  1 , Rajesh Kumar Rajnish  2 , Siddhartha Sharma  1 , Sandeep Patel  1 , Mandeep Singh Dhillon  1 , Sameer Aggarwal  1
Affiliations
Review

Ipsilateral fractures of the ulnar styloid with distal radius fractures; to fix or not? A systematic review and meta-analysis

Prasoon Kumar et al. J Clin Orthop Trauma. .

Erratum in

Abstract

Background: The most common upper limb fracture encountered in clinical practice is distal radius fracture (DRF). They frequently occur due to falls onto an outstretched hand or other traumatic incidents, resulting in a break in the radius near the wrist joint. DRFs often present a spectrum of injuries and are a common reason for emergency department visits, affecting approximately one out of every six patients seeking medical attention in this setting.

Methods: This systematic review was performed according to the guidelines of PRISMA, using the electronic database search of PubMed, Embase, Scopus, and Cochrane Library, and the protocol for the review was registered to PROSPERO. All comparative study designs (prospective or retrospective) that compared fixation of ulnar styloid and no fixation in a case of ipsilateral distal end radius fracture were included.

Results: The current review analyzed 336 patients from five studies, two randomized controlled trials (RCTs), two prospective, and one retrospective comparative study. The meta-analysis revealed a significantly higher rate of union in fixation group than the no-fixation group, with an odds ratio of 10.29 (95%CI 4.74, 22.32; p < 0.00001). However, no significant differences were found in other radiological parameters such as radial inclination, volar angle, and ulnar variance. Regarding functional outcomes, the result was equivocal for the two groups regarding DASH/quick DASH score, Modified Mayo Wrist score MD of 0.22 [95 % CI -1.84, 2.28, p = 0.83; I2 = 0 %], grip strength, range of motion, and overall complications OR of 0.53 (95 % CI 0.08, 3.47; p = 0.51; I2 = 86 %), but higher occurrence of ulnar-sided pain, hardware prominence, and paraesthesias.

Conclusion: Fixation of ulnar styloid in conjunction with DRF does not significantly benefit patients. Despite better styloid union rates, it increases implant-related complications without improving final function, range of motion, stability, or grip strength. Patients may experience increased ulnar-sided pain due to implant prominence. Therefore, non-fixation of the ulnar styloid process is recommended as it offers no significant advantages.

Keywords: Distal radioulnar joint; Distal radius fracture; Fracture fixation; Ulnar styloid fracture; Wrist pain.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:RAJESH KUMAR Rajnish reports was provided by All India Institute of Medical Sciences - Jodhpur. RAJESH KUMAR RAJNISH reports a relationship with All India Institute of Medical Sciences - Jodhpur that includes: employment. RAJESH KUMAR RAJNISH has patent NONE pending to NONE. NONE If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA chart showing study selection.
Fig. 2
Fig. 2
Risk of bias graph of included studies.
Fig. 3
Fig. 3
Risk of bias summary of included studies.
Fig. 4
Fig. 4
Forest plot of Ulnar styloid union.
Fig. 5
Fig. 5
5A Forest plot of Radial inclination, 5B Forest plot of Volar angle, and 5C Forest plot of Ulnar variance.
Fig. 6
Fig. 6
Forest plot of Mayo Wrist score.
Fig. 7
Fig. 7
7A Forest plot of palmer flexion, 7B Forest plot of dorsiflexion.
Fig. 8
Fig. 8
8A Forest plot of supination, and 8B Forest plot of protonation.
Fig. 9
Fig. 9
Forest plot of overall Complications rate.
See this image and copyright information in PMC

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