LAUSR

OBJECTIVES To synthesize all-cause complications and reoperations data, as well as secondary clinical, functional and radiographic outcomes following the management of very distal ulna fractures (VDUFs) either nonoperatively or operatively. DATA SOURCES MEDLINE, Embase and Web of Science, were searched for English-language articles from inception to February 17, 2022. STUDY SELECTION Studies reporting the nonoperative or operative management of VDUFs were eligible for inclusion. VDUFs were defined as either being Q2 to Q5 distal ulna fractures using the AO Comprehensive Classification of Fractures for distal ulna fractures associated with distal radius fractures or being amenable to characterization by Biyani et al.'s classification system for ulnar head, neck and metaphyseal fractures. DATA EXTRACTION Two reviewers independently extracted data from included studies. Study validity was assessed using the methodological index for non-randomized studies. DATA SYNTHESIS Seventeen studies (512 VDUFs) were included for analysis. There were 209, 237 and 66 fractures in the nonoperative, ORIF and distal ulna resection groups, respectively. Descriptive statistics including weighted means, standard deviations and 95% confidence intervals were calculated. CONCLUSIONS The treatment of VDUFs with either nonoperative management, ORIF or distal ulna resection may all be acceptable treatment options in specific patient populations. Nonoperative management of VDUFs is a promising treatment strategy even for complex fracture patterns in patients 65 years of age or older. Despite higher reoperation rates, ORIF may be considered for the younger, high-demand patient. Distal ulna resection presents with very favorable functional outcomes in patients 65 years of age or older presenting with a complex VDUF with the lowest reoperation rate across all groups.