The management of distal ulna fractures remains a subject of considerable debate within orthopedic practice. This systematic review and meta-analysis aim to evaluate the efficacy of surgical versus non-surgical management strategies for distal ulna fractures and their impact on functional outcomes.

This study followed PRISMA guidelines and involved a systematic search of databases like PubMed, Scopus, and Web of Science for relevant studies published in English up to December 2023. The search included keywords such as “ulnar styloid fracture,” “non-surgical management,” “surgical management,” and “treatment outcomes.” Studies were selected based on predefined inclusion and exclusion criteria, and data were extracted on patient demographics, fracture characteristics, treatment details, functional outcomes, patient-reported outcomes, complications, and follow-up duration. The methodological quality of included studies was assessed using the GRADE system. The meta-analysis used standardized mean differences for continuous outcomes and log odds ratios for dichotomous outcomes.

The initial search yielded 1253 studies, which were narrowed down to 12 studies suitable for review after removing duplicates and irrelevant articles. These studies included a total of 709 patients, with 422 receiving non-surgical management and 287 undergoing surgical treatment. The results showed no significant differences in grip strength, DASH score, or VAS score between surgical and non-surgical management. However, a higher union rate was observed with surgical management.

The systematic review revealed a range of studies with varied inclusion and exclusion criteria and differing levels of transparency about their limitations. The studies also showed diversity in patient demographics and fracture characteristics. The management of DUFs varied across studies, with a mix of non-surgical and surgical approaches. Functional outcomes were inconsistent, with some studies suggesting better outcomes for surgical management and others showing comparable or better results for non-surgical management. Secondary outcomes, such as union rates, were generally higher for surgical management, but data on DRUJ instability and subsequent surgeries were lacking in many studies.

While surgical management may offer a higher union rate, the choice of treatment should be individualized, balancing the potential benefits against the risks of surgery, As ORIF implants typically associated with higher ulnar-sided pain rates and limited ulnar deviation due to implant prominence. Future research should focus on standardizing study designs to improve the quality of evidence in the management of distal ulna fractures.