Surgical Management of Unstable Distal Ulnar Fractures With Concomitant Distal Radius Fractures: A Systematic Review

Unstable distal ulnar fractures (DUFs) often accompany distal radius fractures (DRFs) and can cause pain, functional impairment, and long-term instability if not managed appropriately. Given the lack of consensus regarding the optimal surgical technique, we conducted a systematic review to compare outcomes of different surgical treatments for unstable DUFs associated with DRFs. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from inception to July 16, 2025. English studies involving adult patients with surgically treated unstable DUFs concomitant with DRFs were included (ulnar styloid-only fractures excluded). Two independent reviewers screened studies and extracted data on demographics, fracture characteristics, treatment methods, and outcomes. The outcomes were postoperative range of motion, pain, complications, and reoperation rates. Twenty-four studies (608 patients) met inclusion criteria. The mean age was 65 years, 80% were women, and the mean follow-up was 22 months. Surgical techniques included plate fixation (58%), pin and wire fixation (22%), Darrach resection (19%), and screws only (2%). Reoperation occurred in 39 patients (5.5%). Time to union, reported in four studies, averaged 11 weeks. Meta-analyses showed no significant differences among techniques in treatment outcomes. Overall, no fixation technique demonstrated superiority in outcomes, suggesting that multiple surgical strategies can yield satisfactory outcomes when appropriately selected.