Abstract
Purpose In this literature review, functional outcomes such as Disability of Arm, Shoulder
and Hand (DASH) score and the visual analog scale (VAS) of pain along with clinical
outcomes such as range of movement and grip strength of treated distal radius fractures
(DRF) accompanied with ulnar styloid fractures (USF) will be compared with those with
isolated DRF.
Materials and Methods We analyzed articles from MEDLINE, Embase, and CINAHL that met our predetermined
inclusion and exclusion criteria as per the Preferred Reporting Items for Systematic
Reviews and Meta-analysis statements. This resulted in the identification of 464 articles
with 18 potentially eligible studies of which 6 were included at the full-text screening
stage. The primary outcomes were wrist pain, range of motion, functional outcome and
satisfaction, such as VAS, and the DASH questionnaire along with radiological assessment
and incidence of complications.
Results These studies involved 796 participants with DRF and 806 wrists with DRF; 444 (55%)
of DRF had an associated USF. Three studies did not report any statistically significant
difference in DASH scores between the DRF patients with or without USF. Two studies
reported worse DASH scores in the group with associated USF. Wrist pain was reported
to be statistically significantly worse in patients with associated USF in two studies.
Grip strength did not exhibit a statistically significant difference in any groups
in four studies. On assessing the range of motion of the wrist and forearm, only one
study reported a statistically significant difference in flexion at 2 years follow-up,
with less flexion in patients with USF.
Conclusion This review suggests that there is no significant correlation between a USF and the
functional and clinical outcomes of DRF treatment, albeit wrist pain and less flexion
were reported in some studies to be associated with USF. There is a need for more
robust evidence from large randomized controlled trials to specifically look at the
effects of fixation versus nonfixation of USF on DRF, or large prospective cohort
studies assessing DRF with and without USF, with a minimum of 12 months follow-up.
Level of Evidence Level II—therapeutic.
Keywords
radius - fracture - ulnar styloid - DRUJ stability
