Treatment of Unstable Distal Ulna Fractures Associated With Distal Radius Fractures in Patients 65 Years and Older

• Published in: The Journal of hand surgery (American ed.) Vol. 37; no. 12; pp. 2481 - 2487
• Main Authors: Cha, Soo-Min, MD, Shin, Hyun-Dae, MD, PhD, Kim, Kyung-Cheon, MD, PhD, Park, Eugene, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2012
• Subjects: Aged; Distal ulna; elderly; Female; fracture; Fracture Fixation, Internal; Humans; Joint Instability - diagnostic imaging; Joint Instability - surgery; nonoperative; Orthopedics; Prospective Studies; Radiography; Radius Fractures - complications; Radius Fractures - diagnostic imaging; Radius Fractures - physiopathology; Radius Fractures - surgery; Range of Motion, Articular; Ulna Fractures - complications; Ulna Fractures - diagnostic imaging; Ulna Fractures - physiopathology; Ulna Fractures - surgery; unstable; Wrist Joint - physiopathology; unstable; nonoperative; elderly; Distal ulna; fracture
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2012.07.031

Purpose To prospectively compare the clinical and radiological outcomes of 2 treatment methods for unstable distal ulna fractures associated with distal radius fractures in patients 65 years of age and older. Methods From February 2008 to March 2010, the first 29 ulnas were treated surgically (group 1) and the next 32 ulnas were treated nonoperatively (group 2). The mean final follow-up period was 34 months (range, 24–56 mo). All radiuses were fixed internally, in both groups. Clinical outcomes were compared between groups using a visual analog scale for postoperative pain; Disabilities of the Arm, Shoulder, and Hand scores; active range of motion; grip strength; and the modified system of Gartland and Werley. Radiological outcomes, including ulnar variance, were evaluated. Arthrosis was evaluated at the radiocarpal joint or distal radioulnar joint (DRUJ) according to the system of Knirk and Jupiter. Results There were no significant differences between the groups in any of the clinical outcomes. No significant differences were observed for radiological outcomes including ulnar variance, distal radius, and union rate. There were no patients in either group with symptomatic arthritic changes in the radiocarpal joint or DRUJ at the final follow-up. In group 2, 1 patient had malunion (angulated, 14°) on the anteroposterior view without evidence of arthrosis in the DRUJ, and functional outcomes were good. Conclusions In this population distal ulna fractures can be successfully managed nonoperatively when they occur in combination with distal radius fractures. Type of study/level of evidence Therapeutic II.