Non-operative treatment for distal ulna fractures associated with distal radius fractures

Distal ulna fractures often concomitantly occur with distal radius fractures, and their treatment method is still controversial. We hypothesized that osteosynthesis is not necessary for distal radius fracture-associated distal ulna fracture without DRUJ surface fracture. In this study, non-operative treatment was selected for fractures not extending to the distal end of the ulna of the DRUJ based on the Biyani classification, and the therapeutic outcomes were investigated. Retrospective review of 8 patients who had treated with volar locking plate for distal radius fractures and without surgery for distal ulna fractures was performed. The average age of the patients was 74.1 years (range 65-86), and the mean follow up period was 13 months (range 12-15). The exclusion criterion was ulnar styloid fracture. Fracture union and functional outcomes included range of motion of the wrist, Visual Analogue Scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score, and Mayo wrist score were investigated. At the last follow-up, all patients showed bony union. The mean wrist flexion was 65°, extension 66°, pronation 73°, and supination 81°. None of the patients complained of ulna wrist pain, and the average VAS was 1.4/10 and Q-DASH score was 12.7 points. The average Mayo wrist score was 90.3. According to the findings of this study, the Biyani classification based on plain radiograms was suggested to be very useful to decide the indications of treatment. If preoperative evaluation of fracture types is possible, these fractures without DRUJ surface fracture may be sufficiently conservatively treatable.