Operative versus conservative management of metaphyseal ulnar fractures in distal radial fractures fixed with a plate.

Abstract

This study investigated the differences in clinical and radiological outcomes between conservatively and surgically treated distal ulnar metaphyseal fractures associated with distal radial fractures that were fixed with anterior locking plates. Sixty-six patients were retrospectively included. Thirty-five patients had conservative treatment (group C) and 31 surgical fixation (group S). All ulnar fractures were treated with a plate and screws except one fracture that was fixed with K-wires. The final decision for surgical fixation was influenced by individual surgeon preference. Outcomes included Disabilities of the Arm, Shoulder and Hand (DASH) scores, range of motion, grip strength and radiological parameters. Mean follow-up was 33 months for group C and 32 months for group S. The mean DASH score was 14 in both groups. No significant differences were found for range of motion or grip strength. All fractures healed with similar union times. Median ulnar metaphyseal coronal angulation was 9° in group C (IQR 8 to 10) and 2° in group S (IQR 2 to 3). Angular deformity of more than 10° was more frequent in group C than in group S (13/35 vs. 3/31). Despite the lesser angulation, five patients in group S and one patient in group C required additional surgery owing to implant-related complications. With surgical fixation of distal ulnar fractures, radiological outcomes were better than those with closed management, but clinical outcomes were similar and there were more complications. III.