College
Rowan-Virtua School of Osteopathic Medicine
Keywords
Distal Ulna Fracture, Distal Radius Fracture, Intramedullary Screw Fixation, Orthopedic Trauma, Retrospective
IRB or IACUC Protocol Number
iRISID-2024-1548
Date of Presentation
5-1-2025 12:00 AM
Poster Abstract
Background
Distal ulna fractures frequently accompany distal radius fractures but are often underappreciated in both clinical and research contexts. While conservative management is frequently employed, particularly following volar locking plate (VLP) fixation of the radius, certain indications, such as distal radioulnar joint (DRUJ) instability, comminution, or high-energy trauma, may necessitate surgical fixation. This study evaluates patient-reported outcomes among patients with distal radius fractures treated operatively, comparing those with and without concomitant distal ulna fractures, and further stratifying based on the method of ulna fixation.
Methods
This retrospective review included 477 patients treated operatively for distal radius fractures by a single Rothman hand surgeon from 2014 to 2024. Patients were grouped based on the presence and management of a concomitant distal ulna fracture: no ulna fracture, ulna fracture without fixation, or ulna fracture with fixation (plating or intramedullary screw). Visual Analogue Scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were collected and compared across groups.
Results
A total of 477 patients were analyzed in this study. 214 patients sustained a distal radius fracture without an associated distal ulna fracture. Among these, 140 patients had a mean VAS score of 2, and 118 patients had a mean DASH score of 34. In contrast, 248 patients sustained a distal radius fracture with a concomitant distal ulna fracture that was not surgically treated. Of these, 139 patients had a mean VAS score of 5, while 133 patients had a mean DASH score of 48. 15 patients underwent surgical fixation of a concomitant distal ulna fracture. Among the 11 patients treated with a distal ulnar intramedullary screw, eight had a mean VAS score of 1, and five had a mean DASH score of 46. Two patients underwent plating of the distal ulna; one had a VAS score of 0, and one had a DASH score of 59. Overall, for patients who received any form of ulnar fixation, the mean VAS score was 1, and the mean DASH score was 50.
Conclusions
Distal radius fractures without an associated distal ulna fracture are linked to lower pain and better function. Conversely, untreated distal ulna fractures in the setting of distal radius fixation are associated with worse patient-reported outcomes. Surgical fixation of the distal ulna may improve outcomes, with intramedullary screw fixation associated with the lowest VAS scores. Therefore, intramedullary screw fixation may be a viable technique for pain reduction in patients with concomitant distal ulna fractures.
Disciplines
Medicine and Health Sciences | Musculoskeletal Diseases | Musculoskeletal System | Orthopedics | Pathological Conditions, Signs and Symptoms | Surgery | Surgical Procedures, Operative | Trauma | Wounds and Injuries
Included in
Musculoskeletal Diseases Commons, Musculoskeletal System Commons, Orthopedics Commons, Pathological Conditions, Signs and Symptoms Commons, Surgery Commons, Surgical Procedures, Operative Commons, Trauma Commons, Wounds and Injuries Commons
The Use of Intramedullary Screw for Fixation of Distal Ulnar Fractures
Background
Distal ulna fractures frequently accompany distal radius fractures but are often underappreciated in both clinical and research contexts. While conservative management is frequently employed, particularly following volar locking plate (VLP) fixation of the radius, certain indications, such as distal radioulnar joint (DRUJ) instability, comminution, or high-energy trauma, may necessitate surgical fixation. This study evaluates patient-reported outcomes among patients with distal radius fractures treated operatively, comparing those with and without concomitant distal ulna fractures, and further stratifying based on the method of ulna fixation.
Methods
This retrospective review included 477 patients treated operatively for distal radius fractures by a single Rothman hand surgeon from 2014 to 2024. Patients were grouped based on the presence and management of a concomitant distal ulna fracture: no ulna fracture, ulna fracture without fixation, or ulna fracture with fixation (plating or intramedullary screw). Visual Analogue Scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were collected and compared across groups.
Results
A total of 477 patients were analyzed in this study. 214 patients sustained a distal radius fracture without an associated distal ulna fracture. Among these, 140 patients had a mean VAS score of 2, and 118 patients had a mean DASH score of 34. In contrast, 248 patients sustained a distal radius fracture with a concomitant distal ulna fracture that was not surgically treated. Of these, 139 patients had a mean VAS score of 5, while 133 patients had a mean DASH score of 48. 15 patients underwent surgical fixation of a concomitant distal ulna fracture. Among the 11 patients treated with a distal ulnar intramedullary screw, eight had a mean VAS score of 1, and five had a mean DASH score of 46. Two patients underwent plating of the distal ulna; one had a VAS score of 0, and one had a DASH score of 59. Overall, for patients who received any form of ulnar fixation, the mean VAS score was 1, and the mean DASH score was 50.
Conclusions
Distal radius fractures without an associated distal ulna fracture are linked to lower pain and better function. Conversely, untreated distal ulna fractures in the setting of distal radius fixation are associated with worse patient-reported outcomes. Surgical fixation of the distal ulna may improve outcomes, with intramedullary screw fixation associated with the lowest VAS scores. Therefore, intramedullary screw fixation may be a viable technique for pain reduction in patients with concomitant distal ulna fractures.
