Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 3 , ISSUE 2 ( September, 2008 ) > List of Articles

Review

The management of distal ulnar fractures in adults: a review of the literature and recommendations for treatment

A. J. Logan, T. R. Lindau

Keywords : Ulnar fractures, Adult, Injuries, Fracture fixation

Citation Information : Logan AJ, Lindau TR. The management of distal ulnar fractures in adults: a review of the literature and recommendations for treatment. 2008; 3 (2):49-56.

DOI: 10.1007/s11751-008-0040-1

License: CC BY-NC-SA 4.0

Published Online: 01-09-2008

Copyright Statement:  Copyright © 2008; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

The distal ulna represents the fixed point around which the radius and the hand acts in daily living. The significance of distal ulnar fractures is often not appreciated and often results in inadequate treatment in comparison to its larger counterpart; the radius. There is little guidance in the current literature as how to manage these fractures and their associated injuries. This paper aims to critically review the current literature and combine it with treatment suggestions based on the experience of the authors to help guide investigation and management of these often complex injuries.


PDF Share
  1. Hagert CG (1996) Current concepts of the functional anatomy of the distal radioulnar joint, including the ulnocarpal junction. In: Büchler U, Dunitz M (eds) Wrist instability, pp 15-21
  2. Garcia-Elias M (1998) Soft-tissue anatomy and relationships about the distal ulnar. Hand Clin 14(2):165-176
  3. Bowers W (1999) The distal radioulnar joint. In: Green D (ed) Operative hand surgery. Churchill Livingstone, New York, vol 1, pp 986-1032
  4. af Ekenstam F, Hagert CG (1985) The distal radioulnar joint. The influence of geometry and ligament on simulated Colles' fracture. An experimental study. Scand J Plast Reconstr Surg 19(1):27-31
  5. af Ekenstam F, Hagert CG (1985) Anatomical studies on the geometry and stability of the distal radioulnar joint. Scand J Plast Reconstr Surg 19(1):17-25
  6. Palmer AK, Werner FW (1981) The triangular fibrocartilage complex of the wrist. Anatomy and function. J Hand Surg 6A(2):153-162
  7. Palmer AK (1989) Triangular fibrocartilage complex lesions: a classification. J Hand Surg 14A(4):594-606
  8. Hagert CG (1995) Stabilization of the distal radioulnar joint. In: Vastamäki V (ed) Current trends in hand surgery. Elsevier, Amsterdam, pp 197-200
  9. Chidgey LK, Dell PC, Bittar ES, Spanier SS (1991) Histologic anatomy of the triangular fibrocartilage. J Hand Surg 16A(6):1084-1100
  10. Shaw JA, Bruno A, Paul EM (1990) Ulnar styloid fixation in the treatment of posttraumatic instability of the radioulnar joint: a biomechanical study with clinical correlation. J Hand Surg 15A(5):712-720
  11. May MM, Lawton JN, Blazar PE (2002) Ulnar styloid fractures associated with distal radius fractures: Incidence and implications for distal radioulnar joint instability. J Hand Surg 27A(6):965- 971
  12. Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL (1996) Intracarpal soft-tissue lesions associated with an intraarticular fracture of the distal end of the radius. J Bone Joint Surg 78A(3):357-365
  13. Oskarsson GV, Aaser P, Hjall A (1997) Do we understand the predictive value of the ulnar styloid affection in Colles fractures. Arch Orthop Trauma Surg 116(6-7):341-344
  14. Catalano LW 3rd, Cole JR, Gelberman RH, Evanoff BA, Gilula LA, Borrelli J Jr (1997) Displaced intra-articular fractures of the distal aspect of the radius. Long-term results in young adults after open reduction and internal fixation. J Bone Joint Surg 79A(9):1290-1302
  15. Bacorn RW, Kurtzke JF (1953) Colles' fracture: a study of two thousand cases from the New York State Workmans compensation board. J Bone Joint Surg 35A(3):643-658
  16. Frykman G (1967) Fractures of the distal radius including sequelae-shoulder-hand-finger syndrome, disturbance in the distal radioulnar joint and impairment of nerve function: a clinical and experimental study. Acta Orthop Scand Suppl 108:3?
  17. Reeves B (1966) Excision of the ulnar styloid fragment after Colles' fracture. Int Surg 45(1):46-52
  18. Knirk JL, Jupiter JB (1986) Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg 68A(5):647- 659
  19. Buterbaugh GA, Palmer AK (1988) Fractures and dislocations of the distal radioulnar joint. Hand Clin 4(3):361-375
  20. Geissler WB, Fernandez DL, Lamey DM (1996) Distal radioulnar joint injuries associated with fractures of the distal radius. Clin Orthop Relat Res 327:135-146
  21. Adams BD (2005) Distal radioulnar joint instability. In: Green PD, Pederson CW, Hotchkiss RN, Wolfe SW (eds) Greens operative hand surgery, 5th edn. Elsevier, Churchill Livingstone, Amsterdam, vol 1, p 621
  22. Mikic ZD (1995) Treatment of acute injuries of the triangular fibrocartilage complex associated with distal radioulnar joint instability. J Hand Surg 20A(2):319-323
  23. Roysam GS (1993) The distal radioulnar joint in colles' fractures. J Bone Joint Surg 75B(1):58-60
  24. Stewart HD, Innes AR, Burke FD (1985) Factors affecting the outcome of Colles' fracture: an anatomical and functional study. Injury 16(5):289-295
  25. Lindau T, Arner M, Hagberg L (1997) Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg 22B(5):638-643
  26. Lindau T, Adlercreutz C, Aspenberg P (2000) Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar instability after distal radius fractures. J Hand Surg 25A(3):464- 468
  27. Hauck RM, Skahen J 3rd, Palmer AK (1996) Classification and treatment of ulnar styloid nonunion. J Hand Surg 21A(3):418-422
  28. Kiyono Y, Nakatsuchi Y, Saitoh S (2002) Ulnar-styloid nonunion and partial rupture of extensor carpi ulnaris tendon: two case reports and review of the literature. J Orthop Trauma 16(9):674- 677
  29. Xarchas KC, Yfandithis P, Kazakos K (2004) Malunion of the ulnar styloid as a cause of ulnar wrist pain. Clin Anat 17:418-422
  30. Tsukazaki T, Iwasaki K (1993) Ulnar wrist pain after colles' fracture. Acta Orthop Scand 64(4):462-464
  31. Burgess RC, Watson KH (1988) Hypertrophic ulnar styloid nonunions. Clin Orthop Relat Res 228:215-217
  32. Jakab E, Ganos DL, Gagnon S (1993) Isolated intra-articular fractures of the ulnar head. J Orthop Trauma 7(3):290-292
  33. Tamura Y, Inoue G (1998) Dislocation of the distal radioulnar joint associated with an intraarticular fracture of the ulnar head: report of two cases. J Orthop Trauma 12(1):68-70
  34. Solan MC, Rees R, Molloy S, Proctor MT (2003) Internal fixation after intra-articular fracture of the distal ulnar. J Bone Joint Surg 85B(2):279-280
  35. Dennison DG (2007) Open reduction and internal locked fixation of unstable distal ulna fractures with concomitant distal radius fracture. J Hand Surg 32A(6):801-805
  36. Ring D, McCarty LP, Campbell D, Jupiter JB (2004) Condylar blade plate fixation of unstable fractures of the distal ulnar associated with fractures of the distal radius. J Hand Surg 29A(1):103-109
  37. Kang HJ, Shim DJ, Yong SW, Yang GH, Hahn SB, Kang ES (2002) Operative treatment for isolated distal ulnar shaft fracture. Yonsei Med J 43(5):631-636
  38. Grechenig W, Peicha G, Fellinger M (2001) Primary ulnar head prosthesis for the treatment of an irreparable ulnar head fracture dislocation. J Hand Surg 26B(3):269-271
  39. Seitz WH Jr, Raikin SM (2007) Resection of comminuted ulna head fragments with soft tissue reconstruction when associated with distal radius fractures. Tech Hand Up Extrem Surg 11(4):224-230
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.