Inclusion criteria comprised a displaced ulna head fracture associated with a distal radius fracture. Exclusion criteria were an undisplaced ulna head fracture, an isolated ulna styloid fracture, and an isolated distal ulna fracture. From October 2010 to March 2018, 82 consecutive patients with combined distal ulna and distal radius fractures were treated operatively with radius osteosynthesis combined with ulna plate osteosynthesis. Of those 82 patients, 13 had died, 14 were unreachable, and 7 had less than 6 months’ follow-up. A total of 48 patients (59%) were included in this study.
Surgical technique
The first surgical step consisted of distal radius exposure by a modified Henry approach between the flexor carpi radialis and the radial artery, followed by fracture reduction and stabilization using a volar plate. In the second step, the distal ulna was exposed between the extensor carpi ulnaris and flexor carpi ulnaris, followed by fracture reduction and stabilization using a 2.0-mm locking compression plate (LCP) distal ulna hook plate (Depuy Synthes, West Chester, PA). This plate was placed on the lateral side of the ulna shaft and the pointed hooks of the plate were placed around the tip of the ulna styloid. Postoperative management included an antebrachial cast for 6 weeks and progressive active motion at 6 weeks.
Postoperative complications
Complications were reported, including discomfort or pain due to the implant, injury of the dorsal cutaneous branch of the ulnar nerve, complex regional pain syndrome (CRPS), and infection. Fracture nonunion or secondary displacements were also reported.
Clinical evaluation (at last follow-up)
Wrist range of motion was measured with a goniometer. Grip strength and pinch strength were evaluated with hydraulic dynamometers (JAMAR®, Warrenville, IL). Pain was evaluated using the visual analog scale (VAS) [15] at rest and during activity. The patient-related general outcome was measured using the Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score [16] and the Mayo wrist score. The best Q-DASH score is 0% and the best Mayo wrist score is 100%.
Radiographic evaluation (preoperative and at last follow-up)
Preoperative radiographs were reviewed to classify distal ulna fractures according to Biyani [17] and distal radius fractures according to the AO/OTA [18]. Biyani type I is a simple ulna head fracture, type II is an inverted T-fracture, type III is a combined ulna head and ulna styloid fracture, and type IV is a comminuted ulna head fracture. AO/OTA type A is an extraarticular fracture, type B is a partial articular fracture, and type C is a complete articular fracture. Bone union was evaluated on postoperative X-rays. At final follow-up, radial height, ulnar variance, radial inclination, and volar tilt were calculated. Distal radioulnar joint (DRUJ) osteoarthritis was assessed. Ulna plate placement was assessed to confirm its position on the lateral side of the ulna.
Comparison between younger and older patients
Patients were separated into two groups: patients younger than 65 years (group 1) and patients 65 years old or older (group 2). The following variables were compared between these two groups: mechanism, AO/OTA classification, Biyani classification, range of motion, strength, Q-DASH, complications, and DRUJ osteoarthritis.
Statistical analysis
The significance of differences between the two groups was assessed using the Mann–Whitney U test. The statistical analysis was performed using StatPlus version 7.3.1 (Addinsoft, NY, USA). The chosen level of evidence was p < 0.05.
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