The Role of Ulnar Styloid Fixation in Surgically treated Distal Radius Fractures: A Systematic Review

Author(s): Shahmeen Rasul, Rana Ahmed, Manahil Awan, Shahzad Ahmad, Shashwat Shetty, Aliaa Alkhazendar HJ, Jarallah Alkhazendar HJ

Distal radius fractures are frequently associated with ulnar styloid fractures, yet the clinical benefit of fixing the ulnar styloid remains uncertain. This systematic review evaluated whether ulnar styloid fixation improves pain, function, wrist mobility, or distal radioulnar joint (DRUJ) stability following surgical treatment of distal radius fractures. A comprehensive literature search of PubMed, Embase, Scopus, and the Cochrane Library was conducted according to PRISMA 2020 guidelines, including studies comparing outcomes with and without ulnar styloid fixation. Data on pain, functional scores (DASH/PRWE), wrist range of motion, and DRUJ stability were extracted, and risk of bias was assessed using ROBINS-I, AMSTAR 2, or Cochrane RoB 2 tools. Nine studies comprising 680 adult patients were included. Across these studies, routine ulnar styloid fixation did not provide significant improvement in pain, functional outcomes, or wrist mobility. Selective fixation for basal fractures associated with DRUJ instability may offer targeted benefits. Overall, the evidence suggests that routine ulnar styloid fixation is generally unnecessary, and surgical decision-making should prioritize DRUJ assessment to optimize outcomes while minimizing operative morbidity.