Surgical fixation not necessary for concomitant distal ulna fracture during ORIF of distal radius fracture

BOSTON — High rates of healing and similar range of motion were seen in cases of distal radius fracture treated with open reduction and internal fixation and concomitant ulna fracture whether the distal ulna was treated either operatively or nonoperatively, according to a presentation at the American Society for Surgery of the Hand Annual Meeting.

“[We] did not find a benefit to operative management of the distal ulna,” Kevin Lutsky, MD, said during his presentation. “There were no nonunions in the ulna-no [fixation] group and no substantial benefit in terms of range of motion outcomes. Radiographic alignment was similar between groups. Our data do not provide firm guidelines on when the distal ulna fracture requires fixation, but we would suggest the residual growth and stability after stabilization of the radius is a reasonable indication.”

Lutsky and colleagues performed a retrospective review of patients with 164 distal radius fractures who underwent open reduction and internal fixation during a 5-year period. These patients also had a concomitant fracture of the distal ulna identified with radiographic review. Postoperative radiographs were used to determine treatment of the distal ulna fracture and to assess healing of the distal ulna. Patients’ charts were used to determine range of motion (ROM).

Investigators found 17 fractures of the ulna shaft. Ulna fixation was used in 72 patients, while 91 patients were not treated with ulna fixation.

Forty-four patients in the ulna fixation group had fixation with a pin or multiple pins. A headless compression screw was used in one patient. A plate and screws were used in the remainder of patients. Final ROM was available for 54 patients not treated with ulna fixation and for 51 patients treated with ulna fixation.

Of patients treated with fixation, 71 healed. One patient did not heal due to early hardware failure. The hardware was removed, and a distal ulna resection was performed.

“There were no statistical differences in range of motion in terms of wrist extension, flexion and supination,” Lutsky said. – by Monica Jaramillo

Reference:

Lutsky K, et al. Paper 50. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 13-15, 2018; Boston.

Disclosure: Lutsky reports no relevant financial disclosures.