Review Question - QID 4713

The patient has sustained a distal radius fracture and concomitant ulnar styloid fracture. The shuck test is performed after fixation of the distal radius to assess the status of the DRUJ, namely the radioulnar ligaments.

Injuries to the DRUJ often occur with distal radius fractures. The presence of an ulnar styloid fracture may signify injury to the DRUJ. After the distal radius has been fixed, the shuck test is performed. This test is completed with the elbow at 90 degrees of flexion, the forearm in neutral rotation, followed by pronation and supination. The examiner attempts to translate the ulnar in the sagittal plane. Excessive sagittal plane ulnar translation signifies DRUJ injury.

Kim et al. review the effect of ulnar styloid nonunion on functional outcome after distal radius ORIF. Of the 91 patients treated with distal radius ORIF, 22% were found to have a nonunion of the ulnar styloid. There was no difference in wrist functional outcomes, ulnar sided wrist pain, or DRUJ stability.

Sammer et al. reviewed 144 patients undergoing ORIF of the distal radius. The DRUJ was stable in all patients after internal fixation. An ulnar styloid fracture was found in 88 patients. Functional outcome scores were not affected by the presence of an ulnar styloid fracture. Additionally, the size of the fracture, extent of displacement, or healing status did not affect the outcome.

Figure A shows a PA radiograph of the wrist demonstrating a comminuted distal radius fracture with a concomitant ulnar styloid fracture. Illustration A shows an example of the shuck test used to test the DRUJ.

Incorrect Answers:
Answer 2: The ulnar collateral ligament is involved with injuries to the thumb.
Answer 3: The shuck maneuver is not utilized to assess stability of the fracture.
Answers 4, 5: The ulnolunate and ulnotriquetral ligament origins are part of the TFCC, but are not the key stabilizers of the DRUJ.