Is Fixation of the Ulnar Styloid Necessary After Distal Radius Fracture Stabilization?

Introduction Fractures of the distal radius are frequently accompanied by fractures of the ulnar styloid process. Because the triangular fibrocartilage complex attaches to the base of the ulnar styloid and contributes to the stability of the distal radioulnar joint (DRUJ), the optimal management of these fractures remains controversial. While some surgeons advocate fixation of the ulnar styloid fragment to restore joint stability, others believe that fixation may not significantly influence clinical outcomes. Methods This retrospective comparative study included patients presenting with Fernandez type I distal radius fractures associated with a base fracture of the ulnar styloid. Patients were divided into two groups based on the treatment received: those who underwent fixation of the ulnar styloid fragment and those managed without fixation. All distal radius fractures had been stabilized using percutaneous crossed Kirschner wires. In the fixation group, the ulnar styloid fragment had been additionally stabilized using a tension-band wiring technique. Clinical and follow-up data were retrieved from medical records, with a minimum follow-up duration of 12 months. Outcomes were assessed using the Visual Analogue Scale (VAS) for pain, the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) questionnaire, the Mayo Wrist Performance Score, wrist range of motion, and grip strength. Results A total of 121 patients were included (fixation: 63; without fixation: 58). Quick-DASH scores were slightly higher in the fixation group at three months (34.4 ± 13.5 vs. 32.9 ± 5.7, p = 0.027) and six months (29.8 ± 18.2 vs. 19.3 ± 8.2, p = 0.001), but no difference was observed at 12 months (12.7 ± 7.7 vs. 6.4 ± 2.1, p = 0.198). Mayo Wrist Scores, VAS pain scores, wrist range of motion, and grip strength were comparable between the groups at all time points (all p > 0.05). Conclusion Fixation of the ulnar styloid fragment did not provide a measurable long-term functional advantage after distal radius fracture stabilization. Routine surgical fixation of the ulnar styloid may therefore be unnecessary in patients with a stable DRUJ.