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Wieschollek S, Megerle K. [Concomitant injuries of the wrist, distal ulna and distal radioulnar joint in distal radius fractures : Primary operative cotreatment vs. healing with no additional treatment]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:430-436. [PMID: 38592447 DOI: 10.1007/s00113-024-01424-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/10/2024]
Abstract
Distal radius fractures are the most common fractures in adults and account for one quarter of all fractures, with increasing incidence. The number of patients and the requirement of an exact treatment are high. Continuous developments in diagnostic and operative possibilities enable in many cases a high-quality treatment with good clinical outcome; however, radius fractures rarely occur alone but in combination with additional fractures or ligamentous injuries. The frequency and extent of these injuries are not linked to the complexity of the primary injury. The aim is to recognize and correctly diagnose potential concomitant injuries. Many injuries do not need immediate treatment but heal without additional treatment after the radius has been treated. It is important to recognize those injuries which can cause severe complications if untreated; however, exactly this is often difficult. In many cases there is still no consensus if and how concomitant injuries should be treated. This article highlights the most frequent concomitant injuries in distal radius fractures with the possible advantages and disadvantages of cotreatment in order to facilitate decision making.
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Affiliation(s)
- Stefanie Wieschollek
- Zentrum für Handchirurgie, Mikrochirurgie und plastische Chirurgie, Schön Klinik München Harlaching, Harlachinger Straße 51, 81547, München, Deutschland.
| | - Kai Megerle
- Zentrum für Handchirurgie, Mikrochirurgie und plastische Chirurgie, Schön Klinik München Harlaching, Harlachinger Straße 51, 81547, München, Deutschland
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Yu X, Yu Y, Zhang X, Li J, Zhou T, Chen H. Treatment of type II symptomatic ulnar styloid nonunions with reinsertion of the triangular fibrocartilage complex. BMC Musculoskelet Disord 2023; 24:637. [PMID: 37559060 PMCID: PMC10410938 DOI: 10.1186/s12891-023-06718-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/13/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE The purpose of this retrospective study was to introduce an alternative technique for the treatment of type II symptomatic ulnar styloid nonunion by the reinsertion of the triangular fibrocartilage complex and the ulnar collateral ligament. METHODS Between March 2009 and May 2017, 45 patients (34 males and 11 females) suffering from the nonunion of type II ulnar styloid fractures all underwent the subperiosteal resection of the avulsed fragments and the reinsertion of the TFCC and ulnar collateral ligament. Outcome assessments included the ranges of motion of the wrist, grip strength, pain, and Mayo wrist score. The preoperative and postoperative parameters were compared. A P-value less than 0.05 was considered to be statistically significant. RESULT The mean follow-up period was 21.66 ± 7.93 months (range, 12 to 26 months). At the final follow-up, the mean preoperative flexion and extension were 79.32 ± 4.52° and 74.40 ± 4.36° respectively. The mean preoperative pain score, grip strength, and Mayo wrist score were 32.48 ± 4.00; 23.88 ± 8.38 kg, and 77.72 ± 8.31 respectively. The mean postoperative flexion and extension of the wrist were 80.56 ± 6.32° and 75.43 ± 3.12° respectively. The mean postoperative pain score, grip strength, and Mayo wrist score were 12.41 ± 3.27, 26.31 ± 8.30 kg, and 90.71 ± 7.97 respectively. There were significant differences in pain, grip strength, and Mayo wrist score (P < 0.05), but no significant differences concerning the range of motion of the wrist. CONCLUSION In the treatment of the nonunion of type II ulnar styloid fractures, the resection of the avulsed fragments followed by the reinsertion of the TFCC and the ulnar collateral ligament with an anchor was a reliable alternative technique, bringing the satisfactory function of the wrist.
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Affiliation(s)
- Xiaofei Yu
- Department of Hand Surgery, Third Hospital of Heibei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Yadong Yu
- Department of Hand Surgery, Third Hospital of Heibei Medical University, Shijiazhuang, 050051, Hebei, China.
| | - Xu Zhang
- Department of Hand Surgery, Third Hospital of Heibei Medical University, Shijiazhuang, 050051, Hebei, China.
| | - Jia Li
- Department of Hand Surgery, Third Hospital of Heibei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Tong Zhou
- The Second Hospital of Tangshan, Hebei, China
| | - Huan Chen
- The Second Affiliated Hospital of Wannan Medical College, Hebei, China
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Velmurugesan PS, Nagashree V, Devendra A, Dheenadhayalan J, Rajasekaran S. Should ulnar styloid be fixed following fixation of a distal radius fracture? . Injury 2023; 54:110768. [PMID: 37210301 DOI: 10.1016/j.injury.2023.04.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/27/2023] [Accepted: 04/30/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Fracture of the base of the ulnar styloid has shown to have higher incidence of TFCC tears and DRUJ instability leading to nonunion and impaired function. Poorer functional outcomes of the distal radius fracture have been attributed to the untreated associated ulnar styloid fractures while some studies have shown no difference. Thus, the treatment remains controversial. However, it has been shown that fractures at the base of the ulnar styloid have a higher incidence of tears in the triangular fibrocartilage complex (TFCC) and instability in the distal radioulnar joint (DRUJ), which can lead to nonunion and impaired function. Despite this, there are currently no studies comparing the outcomes of surgically and conservatively treated patients. METHODS A retrospective study was conducted to analyze the outcomes of intra-articular distal radius fractures associated with base of ulnar fracture treated with distal radius LCP fixation. The study included 14 patients who were treated surgically and 49 patients who were treated conservatively, with a minimum follow-up of 2 years. Radiological parameters such as union and amount of displacement, VAS score for ulnar-sided wrist pain, functional assessment using the modified Mayo score and the quick DASH questionnaire and complications were analyzed. RESULTS At the final follow-up, the mean scores for pain (VAS), functional outcomes (modified Mayo score), disability (QuickDASH score), range of motion, and non-union rate were found to be statistically insignificant (p > 0.05) between the surgically treated and conservatively treated groups. However, patients with non-union had statistically significant higher scores for pain (VAS), greater post-operative displacement of the styloid, poorer functional outcomes, and higher disability (p < 0.05). CONCLUSION While there was no significant difference in ulnar-sided wrist pain and functional outcomes between the surgically treated and conservatively treated groups, the conservatively treated cases had a higher risk of non-union, which can negatively impact functional outcomes. The amount of pre-operative displacement was found to be a key factor in predicting non-union and can be used as a guide for determining the management of this type of fracture.
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Affiliation(s)
| | - Vasudeva Nagashree
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India.
| | - Agraharam Devendra
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Jayaramaraju Dheenadhayalan
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
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Abdel Khalik H, Lameire DL, Kruse C, Hache PJ, Al-Asiri J. Management of Very Distal Ulna Fractures: A Systematic Review. J Orthop Trauma 2023; 37:e274-e281. [PMID: 36821446 DOI: 10.1097/bot.0000000000002584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To synthesize all-cause complications and reoperations data, and secondary clinical, functional, and radiographic outcomes after 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-Q5 distal ulna fractures using the OTA/AO Comprehensive Classification of Fractures for distal ulna fractures associated with distal radius fractures or being amenable to characterization by the classification system for ulnar head, neck and metaphyseal fractures by Biyani et al. DATA EXTRACTION Two reviewers independently extracted data from included studies. Study validity was assessed using the methodological index for nonrandomized studies. DATA SYNTHESIS Seventeen studies (512 VDUFs) were included for analysis. There were 209, 237, and 66 fractures in the nonoperative, open reduction internal fixation (ORIF), and distal ulna resection groups, respectively. Descriptive statistics including weighted mean values, standard deviations, and 95% confidence intervals were calculated. CONCLUSIONS The treatment of VDUFs with 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. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Darius L Lameire
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada; and
| | - Colin Kruse
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Philip J Hache
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Jamal Al-Asiri
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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Brackertz S, Reissner L, Fritz B, Walker J, Nagy L. Fixed Subluxation of the Distal Radioulnar Joint following Malunion of the Ulnar Styloid Process. J Wrist Surg 2023; 12:199-204. [PMID: 37223387 PMCID: PMC10202586 DOI: 10.1055/s-0042-1750872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/12/2022] [Indexed: 10/14/2022]
Abstract
Purpose Recent literature on significance and treatment of ulnar styloid fractures suggest that the ulnar styloid is not the central problem but the radioulnar ligaments and their impact on joint stability. However, specifically displaced ulnar styloid process fractures that secondarily heal in an ectopic position remain a rare situation for which diagnostics and treatment options remain a topic of discussion. Methods This case series presents four patients with limited supination due to a fixed dorsal subluxation of the distal radioulnar joint (DRUJ). The reason here fore was a significant malunion of ulnar styloid fracture that was addressed by corrective ulnar styloid osteotomy. Three of these osteotomies used three-dimensional (3D) preoperative planning and patient specific guides. Results All patients presented with a significant displacement of the malunited ulnar styloid fracture (average 32-degree rotation and 5-mm translation). In all four patients, the fixed subluxation of the ulnar head was resolved clinically and radiographically, and the forearm rotation restored after corrective osteotomy of the ulnar styloid and fixation in an anatomical position. Conclusion This case series presents a very specific subset of patients with nonanatomically healed ulnar styloid fractures responsible for a chronic DRUJ dislocation and limited prosupination and its treatment. Level of evidence This is a Level IV, therapeutic study.
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Affiliation(s)
- Sophie Brackertz
- Department of Hand Surgery, University Hospital Balgrist, Zurich, Switzerland
| | - Lisa Reissner
- Department of Hand Surgery, University Hospital Balgrist, Zurich, Switzerland
| | - Benjamin Fritz
- Department of Radiology, University Hospital Balgrist, Zurich, Switzerland
| | - Jonas Walker
- Balgrist CARD, Research in Orthopedic Computer Science, Zurich, Switzerland
| | - Ladislav Nagy
- Department of Hand Surgery, University Hospital Balgrist, Zurich, Switzerland
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Marès O, Bosch C. Distal radioulnar joint instability: Diagnosis and treatment of acute and chronic lesions. Orthop Traumatol Surg Res 2023; 109:103465. [PMID: 36942792 DOI: 10.1016/j.otsr.2022.103465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/01/2022] [Indexed: 11/07/2022]
Abstract
Distal radioulnar joint instability is a common clinical condition that can be either acute or chronic. Its management requires extensive knowledge of all the anatomical structures around the wrist area. The clinical examination must identify all damaged structures in order to define a customized reconstruction strategy. The aim of treatment is to prevent the development of chronic instability and/or arthritic lesions, which can only be treated with palliative surgery. Distal radioulnar instability is complex. Its management shares similarities with that of knee instability, with a wide range of conditions ranging from a sprain with isolated ligament tear to complex dislocation in which multiple ligaments are torn. In particular, the triangular fibrocartilage complex, which is a pillar of distal radioulnar joint stability, is not the sole stabilizer of this joint. The treatment strategy is not as simple as just reattaching this ligament to treat all of the acute and chronic clinical signs. The goal of the present study is to describe the various structures and possible lesions in this joint and then how to repair them. The diagnostic and therapeutic difficulties justify treatment at a specialized center.
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Affiliation(s)
- Olivier Marès
- CHU de Nîmes, avenue du Professor Debré, 30000 Nîmes, France.
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Clinical Outcomes of Arthroscopic One-Tunnel Triangular Fibrocartilage Complex Transosseous Suture Repair Are Not Diminished in Cases of Ulnar Styloid Process Fracture Nonunion. Arthroscopy 2023; 39:32-38. [PMID: 35995332 DOI: 10.1016/j.arthro.2022.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/24/2022] [Accepted: 07/28/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether clinical outcomes of arthroscopic one-tunnel wrist triangular fibrocartilage complex (TFCC) transosseous suture repair are not diminished in cases of ulnar styloid process fracture nonunion (USPFN). METHODS Patients who underwent arthroscopic 1-tunnel transosseous suture repair of Palmer 1B foveal TFCC tear (with/without superficial fiber tear; Atzei class 2 or 3 TFCC tear) from 2015 to 2020 were retrospectively reviewed. Group I was the TFCC foveal tear repair group with USPFN. Group II was the TFCC foveal tear repair group without USPFN. In group I, no additional treatment for USPFN was made. Functional preoperative and postoperative outcomes were compared by Modified Mayo Wrist Score (MMWS); Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score; grip strength; pain visual analog scale (VAS); and distal radioulnar joint (DRUJ) stability. Wrist posteroanterior, lateral, and both oblique views of the wrist were used to assess the ulnar styloid process before and after operation. RESULTS This study consisted of 66 patients: group I (n = 22) and group II (n = 44). No differences were found between the 2 groups preoperatively in MMWS, Quick-DASH, grip strength, and VAS (MMWS: P = .94, Quick-DASH: P = .23, grip strength: P = .69, VAS: P = .45). No differences were found between the 2 groups with respect to outcome measures postoperatively in MMWS, Quick-DASH, grip strength, and VAS (MMWS: P = .59, Quick DASH: P = .82, grip strength: P = .15, VAS: P = .84). All of the enrolled patients achieved restored function with negative ballottement test and maintained DRUJ stability on follow-up. Of the 22 USPFN cases in group I, 11 (50%) showed spontaneous union after transosseous TFCC foveal repair without any additional USPFN treatment. The proportion of patients achieving a minimal clinically important difference for the Quick-DASH was similar between the 2 groups. CONCLUSIONS Although this current study has insufficient statistical power, the available data suggest that patients with TFCC foveal tear combined with USPFNs treated with arthroscopic transosseous repair surgery could experience similar functional improvement compared with those with TFCC foveal tear without USPFNs. The presence of USPFN accompanied by Palmer 1B type TFCC foveal tear may not affect the clinical results, including MMWS, Quick-DASH, grip strength, VAS, and DRUJ stability of patients who undergo arthroscopic 1-tunnel transosseous suture repair. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Hosokawa T, Tajika T, Suto M, Chikuda H. Factors Affecting Functional Recovery After Volar Locking Plate Fixation for Distal Radius Fractures. Hand (N Y) 2022; 17:111S-117S. [PMID: 35301907 PMCID: PMC9793624 DOI: 10.1177/15589447221082156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is still no certainty about factors delaying functional recovery after surgery, although volar locking plate (VLP) fixation is the mainstay of treatment for distal radius fractures (DRFs), and several good postoperative recoveries have been reported. The purpose of this study was to investigate factors affecting functional recovery after VLP fixation for DRF. METHODS The subjects included 104 patients (84 females, 20 males, mean age: 63.2 ± 13.8 years) treated with VLP fixation for DRF, who could be followed for 1 year. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, grip strength, and range of motion of the wrist joint were measured at 3, 6, and 12 months postoperatively, and the primary outcome was the QuickDASH score. A multiple regression analysis adjusted for age and sex was used to analyze factors affecting functional recovery at 12 months. RESULTS A multiple regression analysis showed that the factors that significantly influenced the QuickDASH score at 1 year postoperatively were the grip strength ratio to the uninjured side, dominancy of the injured hand, and postoperative ulnar variance, in descending order of involvement. Trauma energy, history of diabetes, fracture type, complications, and range of motion were not included in the model. CONCLUSIONS Smaller grip strength, dominant-hand injury, and larger postoperative ulnar variance significantly worsened the QuickDASH score at 1 year postoperatively. In order to achieve satisfactory functional recovery at 1 year after surgery, we confirmed that it is important to surgically achieve smaller postoperative ulnar variance and increase grip strength.
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Affiliation(s)
- Takafumi Hosokawa
- Tone Chuo Hospital, Numata, Japan
- Gunma University Graduate School of
Medicine, Maebashi, Japan
| | - Tsuyoshi Tajika
- Gunma University Graduate School of
Health Sciences, Maebashi, Japan
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Afifi A, Mansour A. Is it necessary to fix basal fractures of the ulnar styloid after anterior plate fixation of distal radius fractures? A randomized controlled trial. J Hand Surg Eur Vol 2022; 48:544-550. [PMID: 36448506 DOI: 10.1177/17531934221140730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
The purpose of this study was to investigate the necessity for surgical fixation of basal fractures of the ulnar styloid without distal radioulnar joint (DRUJ) instability, after stabilization of associated distal radial fractures using an anterior plate. This single-centre, prospective, randomized controlled trial, conducted between 2015 to 2021, included 43 patients in each study arm who were randomized to either fixation (Group A) or non-operative treatment (Group B) of the ulnar styloid. The mean follow-up period was 24 months (SD 5.2) in Group A and 23.9 months (SD 5.5) in Group B. At the final follow-up, patients were evaluated by the Disabilities of the Shoulder, Arm, and Hand (DASH) score, the Modified Mayo Wrist Score (MMWS), the visual analogue scale (VAS) for pain, the grip strength, wrist range of motion. The DASH score was 6 (SD 2.6) in Group A and 6 (SD 2.4) in Group B; the MMWS was 87 (SD 5.6) in Group A and 87 (SD 5.6) in Group B; and the grip strength was 88% (SD 9.4) in Group A and 87% (SD 7.7) in Group B. In conclusion, fixation of basal ulnar styloid fractures is not mandatory if the DRUJ is stable after rigid fixation of the associated fracture of the distal radius.Level of evidence: II.
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Affiliation(s)
- Ahmed Afifi
- Hand and Microsurgery Unit, Department of Orthopedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman Mansour
- Hand and Microsurgery Unit, Department of Orthopedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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Lee JI, Park JW, Park KC, Kim DH, Lee DH. Predictors for nonunion of unrepaired ulnar styloid fracture associated with distal radius fractures in patients treated with volar locking plate fixation and their effect on functional outcomes. Orthop Traumatol Surg Res 2022; 108:103322. [PMID: 35577276 DOI: 10.1016/j.otsr.2022.103322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/16/2021] [Accepted: 01/24/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Nonunion of ulnar styloid fractures after radius stabilisation by volar locking plate (VLP) fixation without surgical fixation on ulnar styloid fractures is quite common. However, the factors affecting the nonunion of ulnar styloid fractures and their effect on functional outcomes in patients with distal radius fractures (DRFs) treated with VLP fixation are unclear. HYPOTHESIS The purpose of this study was to investigate the predictors affecting nonunion of unrepaired ulnar styloid fractures in patients with DRFs and the effect of nonunion and its predictors on functional outcomes. MATERIALS AND METHODS We retrospectively reviewed data from 84 patients with DRF who underwent VLP fixation. None of the accompanying ulnar styloid fractures were manipulated during the surgery. Postoperative evaluation included the measurement of the grip strength, wrist range of motion, and Disabilities of the Arm, Shoulder, and Hand score at a minimum of one year postoperatively. Patients were divided into the nonunion and union groups according to the presence of union of ulnar styloid fracture. Demographic and radiologic parameters, including age, sex, bone mineral density, location and displacement distance of ulnar styloid fracture, and fracture pattern of DRFs, were analysed to identify predictors of nonunion. Functional outcomes were compared between the two groups and were compared according to the presence of predictors of nonunion. RESULTS Univariate analysis revealed that the nonunion rate was higher in ulnar styloid non-base fractures, substantial displacement (≥1.9mm) of ulnar styloid fracture, and AO/OTA C-type DRF. However, multivariate logistic regression analysis showed that non-base fractures and substantial displacement were significant predictors. Accompanying ulnar styloid fracture nonunion and its predictors were found not to influence functional outcomes. DISCUSSION Substantial displacement and non-base fracture are predictive factors for nonunion of unrepaired ulnar styloid fractures after DRF treatment with VLP fixation. However, nonunion and its predictors do not influence the overall wrist function. These findings suggest that the ulnar styloid fracture accompanying DRF should not be considered a fracture affecting the wrist function when treating with VLP fixation. LEVEL OF EVIDENCE III, Retrospective, Case Control study.
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Affiliation(s)
- Jung Il Lee
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, South Korea.
| | - Jong Woong Park
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Ki-Chul Park
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Dong Hong Kim
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, Ewha Women's University Mokdong Hospital, Seoul, South Korea
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Volar locking plate fixation for distal radius fractures: did variable-angle plates make difference? INTERNATIONAL ORTHOPAEDICS 2022; 46:2165-2176. [PMID: 35690670 PMCID: PMC9372011 DOI: 10.1007/s00264-022-05469-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/01/2022] [Indexed: 11/06/2022]
Abstract
Purpose Two different locking plate designs are now being used for volar plating of the distal radius fractures based on the freedom of screw direction; the fixed-angle, and the variable-angle (polyaxial) plates. We investigated the clinical and radiographic outcomes of both designs. Methods We reviewed 96 patients with 113 unstable distal radius fractures that were operated on with volar locking plates. The patients’ mean age was 41 years. Fixed-angle volar locking plates were utilized in 65 fractures and variable-angle volar locking plates in 48 fractures through modified Henry approach or extended carpal tunnel approach. Full clinical and radiographic evaluation was done for all patients with a mean follow-up of 14 months. Results All patients had acceptable clinical and radiographic parameters. The overall functional results (Mayo score, Quick Disability of Arm, Shoulder, and Hand (Q-DASH) score, Range of motion (ROM), and grip strength) were in favor of the variable-angle plate. The radiographic parameters were better with the variable-angle group. The variable-angle group recorded less operative time but more mean image intensifier exposure time. There were two cases of flexor tendon rupture with the fixed-angle group. Fixation with the fixed-angle system needed K-wire augmentation more than the variable-angle group. There was a positive correlation between hand dominance and the final score. Conclusion Distal radius volar locking plates yield satisfactory results comparable among different designs. In our series, the variable-angle system showed slightly better function and radiographic outcomes. Supplementary K-wires were needed more frequently with the fixed-angle system.
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Costa ML, Achten J, Ooms A, Png ME, Cook J, Dritsaki M, Lamb SE, Lerner R, Draper K, Campolier M, Dakin H, McGibbon A, Parsons N, Hedley H, Dias J. Moulded cast compared with K-wire fixation after manipulation of an acute dorsally displaced distal radius fracture: the DRAFFT 2 RCT. Health Technol Assess 2022; 26:1-80. [PMID: 35152940 DOI: 10.3310/rlcf6332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patients with a displaced fracture of the distal radius are frequently offered surgical fixation. Manipulation of the fracture and moulded plaster casting is an alternative treatment that avoids metal implants, but evidence of its effectiveness is lacking. OBJECTIVE To compare functional outcomes, quality-of-life outcomes, complications and resource use among patients with a dorsally displaced fracture of the distal radius treated with manipulation and surgical fixation with Kirschner wires (K-wires) and those treated with manipulation and moulded cast. DESIGN Pragmatic, superiority, multicentre, randomised controlled trial with a health economic evaluation. SETTING A total of 36 orthopaedic trauma centres in the UK NHS. PARTICIPANTS Patients (aged ≥ 16 years) treated for an acute dorsally displaced fracture of the distal radius were potentially eligible. Patients were excluded if their injury had occurred > 2 weeks previously, if the fracture was open, if it extended > 3 cm from the radiocarpal joint or if it required open reduction, or if the participant was unable to complete questionnaires. INTERVENTIONS Participants were randomly assigned in theatre (1 : 1) to receive a moulded cast (i.e. the cast group) or surgical fixation with K-wires (i.e. the K-wire group) after fracture manipulation. MAIN OUTCOME MEASURES The primary outcome measure was the Patient-Rated Wrist Evaluation score at 12 months, analysed on an intention-to-treat basis. Health-related quality of life was recorded using the EuroQol-5 Dimensions, five-level version, and resource use was recorded from a health and personal social care perspective. RESULTS Between January 2017 and March 2019, 500 participants (mean age 60 years, 83% women) were randomly allocated to receive a moulded cast (n = 255) or surgical fixation with K-wire (n = 245) following a manipulation of their fracture. A total of 395 (80%) participants were included in the primary analysis at 12 months. There was no difference in the Patient-Rated Wrist Evaluation score at 1 year post randomisation [cast group: n = 200, mean score 21.2 (standard deviation 23.1); K-wire group: n = 195, mean score 20.7 (standard deviation 22.3); adjusted mean difference -0.34 (95% confidence interval -4.33 to 3.66); p = 0.87]. A total of 33 (13%) participants in the cast group required surgical fixation for loss of fracture position in the first 6 weeks, compared with one participant in the K-wire group (odds ratio 0.02, 95% confidence interval 0.001 to 0.10). The base-case cost-effectiveness analysis showed that manipulation and surgical fixation with K-wires had a higher mean cost than manipulation and a moulded cast, despite similar mean effectiveness. The use of K-wires is unlikely to be cost-effective, and sensitivity analyses found this result to be robust. LIMITATIONS Because the interventions were identifiable, neither patients nor clinicians could be blind to their treatment. CONCLUSIONS Surgical fixation with K-wires was not found to be superior to moulded casting following manipulation of a dorsally displaced fracture of the distal radius, as measured by Patient-Rated Wrist Evaluation score. However, one in eight participants treated in a moulded cast required surgery for loss of fracture reduction in the first 6 weeks. After a successful closed reduction, clinicians may consider a moulded cast as a safe and cost-effective alternative to surgical fixation with K-wires. FUTURE WORK Further research should focus on optimal techniques for immobilisation and manipulation of this type of fracture, including optimal analgesia, and for rehabilitation of the patient after immobilisation. TRIAL REGISTRATION This trial is registered as ISRCTN11980540 and UKCRN Portfolio 208830. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Matthew L Costa
- Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Juul Achten
- Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alexander Ooms
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - May Ee Png
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jonathan Cook
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Melina Dritsaki
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,College of Medicine and Health, St Luke's Campus, University of Exeter, Exeter, UK
| | - Robin Lerner
- Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Blizard Institute, Queen Mary University of London, London, UK
| | - Kylea Draper
- Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Marta Campolier
- Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Helen Dakin
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alwin McGibbon
- Patient and public involvement group member, Wimbourne, UK
| | - Nicholas Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Hedley
- Department of Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Joseph Dias
- AToMS Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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Clementsen SØ, Jakobsen RB, Hammer OL, Randsborg PH. The Effect of Ulnar Styloid Fractures on Patient-Reported Outcomes After Surgically Treated Distal Radial Fractures. JB JS Open Access 2022; 7:JBJSOA-D-22-00021. [PMID: 36159082 PMCID: PMC9489150 DOI: 10.2106/jbjs.oa.22.00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Ulnar styloid fractures (USFs) are often associated with distal radial fractures (DRFs). When unstable DRFs are treated surgically, any associated USF is most commonly left untreated. The purpose of this study was to evaluate the effect of a concomitant USF on outcome after surgical stabilization of a DRF.
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Affiliation(s)
- Ståle Ørstavik Clementsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
- Email for corresponding author:
| | - Rune Bruhn Jakobsen
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ola-Lars Hammer
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Per-Henrik Randsborg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
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Maniglio M, Park IJ, Zumstein M, Kuenzler M, McGarry MH, Lee TQ. The Critical Size of Ulnar Styloid Fragment for the DRUJ Stability. J Wrist Surg 2021; 10:385-391. [PMID: 34631290 PMCID: PMC8489997 DOI: 10.1055/s-0041-1726309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/03/2021] [Indexed: 10/21/2022]
Abstract
Background Ulnar styloid fractures can be associated with clinically significant instability of the distal radioulnar joint (DRUJ). However, the exact fragment size that results in DRUJ instability is unknown. Purpose The objective of this study was to determine the critical size of an ulnar styloid fracture that would result in a significant increase in DRUJ translation and forearm rotation. Methods Eight cadaveric specimens were used to investigate the effects of three different ulnar styloid fracture sizes on DRUJ instability: tip fracture, base fracture, and a fracture including the fovea. Forearm rotation and dorsopalmar DRUJ translation were measured after each sequential increase in fracture size. Results Relative to the uninjured state, a significant increase in forearm rotation and dorsopalmar translation was found for all three fractures. However, the fovea fracture showed a statistically significant increase in forearm rotation compared with all other fracture types and a statistically significant increase in total dorsopalmar translation compared with the tip fracture. Conclusion In this study, ulnar styloid fractures involving the fovea resulted in significantly greater DRUJ instability comparted to tip and base fractures alone. This study provides important biomechanical data regarding the critical size of ulnar styloid fractures that result in DRUJ instability and may aid in the surgical decision-making algorithm in these patients.
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Affiliation(s)
- Mauro Maniglio
- Department of Orthopaedics and Traumatology; Inselspital Bern, University Hospital, Bern, Switzerland
| | - Il Jung Park
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California
| | - Matthias Zumstein
- Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Michael Kuenzler
- Department of Orthopaedics and Traumatology; Inselspital Bern, University Hospital, Bern, Switzerland
| | - Michelle H. McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California
| | - Thay Q. Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California
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Maniglio M, Fraipont W, Flueckiger R, Zumstein MA, McGarry MH, Lee TQ. What's the best surgical repair technique of an ulnar styloid fracture? A biomechanical comparison of different techniques. Injury 2021; 52:2835-2840. [PMID: 34281690 DOI: 10.1016/j.injury.2021.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/13/2021] [Accepted: 06/25/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION 8-10% of all Ulnar styloid fractures (USF) accompanying distal radius fractures are addressed surgically. The surgical fixation has to counteract forces of translation and rotation acting on the distal radioulnar joint (DRUJ). The different technics used were never compared biomechanically. Our study aims to compare the effects of different techniques of USF fixation on the forearm rotation and the dorsal-palmar (DP)-translation of the DRUJ. MATERIAL AND METHODS 9 forearm specimens were mounted on a custom testing system. Load was applied for Pronosupination and DP-translation with the forearm placed in neutral position, pronation and supination. The positional change of the DRUJ was measured using a MicroScribe. Six different, sequential conditions were tested in the same specimen: intact, USF and 4 repair techniques (2 K-wire, tension band wiring (TBW), headless compression screw, suture anchor). RESULTS The USF significantly increased DP-translation and pronosupination compared to the intact condition. The DP-translation in neutral was reduced significantly with all four techniques compared to the USF condition. TBW and suture anchor also showed a significant difference to the K-wire fixation. In supination only the TBW and suture anchor significantly decreased DP-Translation. The rotational stability of the DRUJ was only restored by the K-wire fixation and the TBW. CONCLUSIONS All four USF repair techniques partially restored translational stability; however, only K-wire fixation and TBW techniques restored rotational stability. TBW was biomechanically superior to the other techniques as it restored translational stability and rotational stability.
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Affiliation(s)
- Mauro Maniglio
- Department of Orthopaedics and Traumatology; Inselspital Bern, University Hospital, Bern, Switzerland
| | - William Fraipont
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundatiom, Pasadena, CA, USA.
| | - Remy Flueckiger
- Department of Orthopaedics and Traumatology; Inselspital Bern, University Hospital, Bern, Switzerland.
| | - Matthias A Zumstein
- Department of Orthopaedics and Traumatology; Inselspital Bern, University Hospital, Bern, Switzerland; Orthopaedics Sonnenhof, Salvisbergstrasse 4, Bern CH-3006, Switzerland; Stiftung Lindenhof I Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, Freiburgstrasse 3, Bern CH-3010, Switzerland.
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundatiom, Pasadena, CA, USA.
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundatiom, Pasadena, CA, USA.
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Ludvigsen T, Matre K, Vetti N, Kristoffersen PM, Toppe MK, Gudmundsdottir R, Krukhaug Y, Dybvik E, Fevang JM. Is there a correlation between functional results and radiographic findings in patients with distal radius fracture A0 type A3 treated with volar locking plate or external fixator? OTA Int 2021; 4:e142. [PMID: 34746674 PMCID: PMC8568390 DOI: 10.1097/oi9.0000000000000142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/13/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED The aim of this study was to test the hypothesis that precise restoration of distal radius fractures is correlated to better patient-reported outcome. METHODS The correlation between radiographic results and functional outcome was explored in 156 patients with extra-articular distal radius fractures included in a multicenter, randomized controlled trial comparing 2 surgical interventions, Volar Locking Plate or External Fixator. The primary functional outcome was the Patient Rated Wrist and Hand Evaluation score (PRWHE). Radiographically we assessed volar tilt, radial inclination, radial height, ulnar variance, and the presence of ulnar styloid fracture. The Pearson correlation analysis was used to estimate correlations between parameters. RESULTS At 1-year follow-up the mean difference in radiographic findings compared with the uninjured side (min, max) was: reduced volar tilt 5.3° (-15°, 25°), reduced radial inclination 2.3° (-6°, 12°), radial height 1.3 mm (-4 mm, 7 mm), and ulnar variance -0.5 mm (-6 mm, 3 mm). Overall, we found no correlation between radiographic parameters and the PRWHE at 1-year follow-up within the whole group, regardless of which treatment was chosen. At the time of injury 53% (N = 80) had sustained an additional ulnar styloid fracture. After 1 year this fracture was still radiographically present in 31% (N = 43) of the patients. No correlation between PRWHE score and the presence of an ulnar styloid fracture at 1-year follow-up was found. CONCLUSIONS We found no correlation between functional outcome (PRWHE) and radiographic findings after 1 year in patients operated on with a Volar Locking Plate or External Fixator. Patient-specific factors were more important than radiographic measurements in this study group.Level of evidence: Therapeutic Level 2Trial registration: Norway: National Committee for Medical and Health Research Ethics 213/555ClinicalTrials.gov ID: NCT01904084Randomization of first patient: 02.09.2013.
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Affiliation(s)
- Trine Ludvigsen
- University of Bergen, Bergen
- Orthopaedic Department, Voss Hospital, Voss
| | - Kjell Matre
- University of Bergen, Bergen
- Orthopaedic Department, Haukeland University Hospital
| | - Nils Vetti
- University of Bergen, Bergen
- Radiology Department
| | | | | | | | - Yngvar Krukhaug
- University of Bergen, Bergen
- Orthopaedic Department, Haukeland University Hospital
| | - Eva Dybvik
- Norwegian National Advisory Unit on Arthroplasty and Hip Fractures, Bergen, Norway
| | - Jonas Meling Fevang
- University of Bergen, Bergen
- Orthopaedic Department, Haukeland University Hospital
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17
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Morisaki S, Tsuchida S, Oda R, Takahashi K. Conservative treatment of ulnar styloid fractures following volar-plate fixation of distal radius fractures: incidence of nonunion evaluated by computed tomography. Eur J Trauma Emerg Surg 2021; 48:2247-2254. [PMID: 34417629 DOI: 10.1007/s00068-021-01770-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The first aim of this study was to investigate the incidence of ulnar styloid fractures (USFs) accompanied by distal radius fractures (DRFs), treated with volar locking plates. The fracture type of DRFs was evaluated by the classifications, based on computed tomography (CT) scan findings. The second aim was to investigate the bone union rate of USFs, depending on the fracture type of DRFs, by comparing union and nonunion groups in the USFs groups. METHODS Between May 2012 and December 2019, 239 consecutive patients with DRFs were treated. Of these patients, 177 DRFs met inclusion criteria. The fracture patterns of the DRFs, based on the classification, using CT scans, which included the AO classification, sagittal angulation, and axial fracture patterns of the articular surface of the distal radius in two-part intra-articular fractures were evaluated. The size of USFs, classified as a tip or base fracture was also investigated. RESULTS The incidence of USFs was significantly higher for AO types A and C than for type B. Analysis of the sagittal angulation of DRFs showed that the incidence of USFs was higher for the extension type than for the flexion type. Axial CT classification of two-part fractures revealed that DRFs with a dorsal fracture line was more frequent than the volar type of DRFs. These results suggested that dorsal displacement of DRFs was associated with a higher incidence of USFs. Finally, the analysis of the bone union rate of USFs revealed that AO classification and sagittal angulation were not correlated with bone union in USFs. However, it was found that a fracture line on the radial side of the radius had a significantly low rate of bone union, compared to a fracture line on the dorsal side. The size of USFs was also not correlated with the bone union rate. CONCLUSIONS The incidence and the bone union rate of USFs have different patterns. The incidence of USFs was higher in the dorsal displacement type of DRFs. However, the bone union rate of USFs was lower for a fracture line on the radial side. Therefore, USFs with DRFs that have a fracture line on the radial side is a candidate for fixation to prevent nonunion.
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Affiliation(s)
| | | | - Ryo Oda
- Saiseikai Shigaken Hospital, Ritto, Japan
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18
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Abstract
Distal radial fractures are associated with good outcomes; however, although they occur at low rates, complications can significantly impair treatment success. Therefore, the treating surgeon should be aware of potential complications associated with each treatment type and how to best prevent them. Although certain patient-specific and fracture-specific factors may increase the risk of adverse outcomes, most are nonmodifiable risk factors at the time of presentation, so it is imperative that every effort is made to mitigate these risk factors to prevent long-term morbidity. Patients should be well-informed about these complications and potential symptoms so that they can be addressed expeditiously.
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Affiliation(s)
- Hayden S Holbrook
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA.
| | - Travis A Doering
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Benjamin M Mauck
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
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19
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[Surgical treatment of the ulnar styloid process using an angle-stable hook plate in fractures and symptomatic nonunions]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2021; 33:430-435. [PMID: 34081175 DOI: 10.1007/s00064-021-00709-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/10/2020] [Accepted: 09/15/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Anatomical reduction of dislocated fractures using an angle-stable hook plate. Surgical revision of symptomatic nonunions with the aim of bone regeneration. INDICATIONS Dislocated fractures of the ulnar styloid process with involvement of the ulnar fovea. Combined fractures with instability of the distal radioulnar joint and symptomatic nonunions. CONTRAINDICATIONS Undisplaced fractures of the ulnar styloid process and asymptomatic nonunions. SURGICAL TECHNIQUE Dorsoradial access to the distal ulna between the 6th extensor tendon compartment and the tendon of the flexor carpi ulnaris muscle. Exposition of the fracture/nonunion. In case of nonunions, excision and freshening of the fracture ends. Reduction is carried out using the hooks of the plate, if necessary additional attachment of autologous cancellous bone in case of nonunions. Fixation of the plate over the gliding hole and subsequent filling of the angular stable screw holes. POSTOPERATIVE MANAGEMENT Depending on the accompanying injury, immobilization in a forearm plaster splint for 1-2 weeks. Active movement exercises of the fingers from postoperative day 1, if necessary lymph drainage. After bone development, load build-up under ergotherapy guidance. RESULTS Bony healing was achieved in 100% of our cases. The surgical treatment of symptomatic nonunions as well as dislocated fractures of the ulnar styloid process using an angle-stable hook plate has proven to be successful.
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Abstract
In this article, we discuss the incidence and types of injuries to the distal radioulnar joint (DRUJ) that occur in the setting of a distal radius fracture. We review the anatomy of the distal radioulnar joint, which is critical to understanding its biomechanics, and how injury could cause symptomatic incongruency and instability. We highlight how patients with an injury to the distal radioulnar joint might present both at the time of injury and after treatment of a distal radius fracture, the appropriate workup, the available treatment options, and the evidence-based literature.
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Affiliation(s)
- Christina Nypaver
- Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - David J Bozentka
- Department of Orthopaedic Surgery, University of Pennsylvania, Penn Presbyterian Medical Center, 3737 Market Street, Philadelphia, PA 19104, USA
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Okoli M, Silverman M, Abboudi J, Jones C, Kirkpatrick W, Liss F, Takei TR, Wang M, Ilyas AM. Radiographic Healing and Functional Outcomes of Untreated Ulnar Styloid Fractures Following Volar Plate Fixation of Distal Radius Fractures: A Prospective Analysis. Hand (N Y) 2021; 16:332-337. [PMID: 31286791 PMCID: PMC8120582 DOI: 10.1177/1558944719855445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Ulnar styloid fractures (USFs) are common concomitant injuries associated with distal radius fractures (DRFs). Recent studies have found conflicting evidence on whether these fractures treated or untreated effect pain and functional outcomes. The purpose of this study was to prospectively evaluate pain and function outcomes of consecutively untreated USFs in surgically repaired DRFs. The study hypothesis was that there would be no difference in outcomes whether an USF is present or not, with all cases left untreated. Methods: A prospective study at a single institution of consecutive DRF treated surgically with volar locked plating was undertaken. No patients underwent fixation of an USF if present. There were no treated USF that were excluded. Patients with associated ulnar neck and shaft fractures were excluded. Functional outcome measures were analyzed using the Quick Disabilities of the Arm, Shoulder, and Hand score (QDASH) and the Patient-Rated Wrist Evaluation (PRWE) scores. Outcome measures were collected at 3 months and 1 year postoperatively. Results: There was an incidence of 52.2% (n = 70/134) USF associated with surgically treated DRF. By location, there were 52.9% (n = 37/70) ulnar styloid tip fractures and 46.1% (33/70) ulnar styloid base. There were 75.7% of USF (53/70) still not healed by 1-year follow-up. When comparing patients with a DRF without an USF versus DRF with an associated USF at 12 months, there was no statistical difference in the QDASH score (6.7 vs 8.4, P = .47) or the PRWE total score (4.8 vs 7.5, P = .24). Similarly, subgroup analysis showed no statistical difference in QDASH or PRWE scores at final follow-up in united USF versus nonunited USF subjects (QDASH 14.2 vs 6.8, P = .112; PRWE 14.8 vs 5.4, P = .185). Conclusions: USFs are a common concomitant injury occurring in nearly half of DRFs treated surgically. Our prospective cohort analysis showed that neither the presence, type, nor bony union status of a concomitant USF has any significant effect on patient outcomes or reoperations at 1-year postoperatively. Our study confirms our hypothesis that USF of the tip and base should be left untreated.
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Affiliation(s)
- Michael Okoli
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Silverman
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jack Abboudi
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher Jones
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Frederic Liss
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - T. Robert Takei
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark Wang
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Asif M. Ilyas
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA,Asif M. Ilyas, Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA.
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Nakamura T, Moy OJ, Peimer CA. Relationship between Fracture of the Ulnar Styloid Process and DRUJ Instability: A Biomechanical Study. J Wrist Surg 2021; 10:111-115. [PMID: 33815945 PMCID: PMC8012095 DOI: 10.1055/s-0040-1719041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
Background There has been clinical question in the treatment of ulnar styloid fracture with distal radius fracture, surgical fixation of the styloid fragment, or ignorance of the fragment. We examined relationship between size of the ulnar styloid fracture and distal radioulnar joint (DRUJ) stability biomechanically to answer the above clinical question. Methods Changes in the dorsopalmar stiffness of the DRUJ after experimentally simulating in four types of ulnar styloid fractures were examined in cadavers. After tip, middle, base-horizontal, and base-oblique type of styloid fractures were made sequentially, changes in dorsopalmar DRUJ stiffness were measured using the MTS machine in the intact wrist, for each fracture, at 60 degrees pronation, neutral, and 60 degrees supination, respectively. Additional cutting of the radioulnar ligament (RUL) at the fovea was also simulated with the base-horizontal fracture. Results The tip and middle type fractures did not demonstrate significant loss of stiffness compared with the intact. The base-horizontal fracture demonstrated only significant loss of stiffness in the dorsal direction (radius palmar; ulnar dorsal) with forearm in neutral rotation. The base-oblique fracture demonstrated significant loss of dorsopalmar stiffness of the DRUJ. Additional section of the RUL with the base-horizontal fracture induced significant loss of stiffness of the DRUJ compared with the intact. Conclusions Because the RUL originates from the fovea as well as from the base of the ulnar styloid, these results suggest that DRUJ instability closely correlates with how much of the bony fragment includes the originating portions of the RUL. The findings further suggest that larger base-oblique and base-horizontal fragments with resultant DRUJ instability must be reattached, but that even base-horizontal fragment as well as tip and middle ulnar styloid fragment can be ignored when there is no instability.
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Affiliation(s)
- Toshiyasu Nakamura
- Hand Center of Western New York, State University of New York at Buffalo, Buffalo, New York
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan
| | - Owen J. Moy
- Hand Center of Western New York, State University of New York at Buffalo, Buffalo, New York
| | - Clayton A. Peimer
- Hand Center of Western New York, State University of New York at Buffalo, Buffalo, New York
- Department of Orthopaedic Surgery, Marquette General Hospital, Marquette, Michigan
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Klifto KM, Hein RE, Klifto CS, Pidgeon TS, Richard MJ, Ruch DS. Outcomes Associated With Scapholunate Ligament Injury Following Intra-Articular Distal Radius Fractures. J Hand Surg Am 2021; 46:309-318. [PMID: 33526293 DOI: 10.1016/j.jhsa.2020.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 09/26/2020] [Accepted: 12/09/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate a series of intra-articular distal radius fractures (DRFs) to determine whether patients without radiographic evidence of scapholunate (SL) ligament injury have a difference in outcomes in comparison with patients with radiographic evidence of SL ligament injury and no ligament repair or reconstruction. Our hypothesis is that there are no significant differences in outcomes between patients after treatment of their intra-articular DRF. METHODS A retrospective analysis of patients from a single institution who sustained an intra-articular DRF from January 2006 through January 2019 with minimum 12-month (n = 192) and 24-month (n = 100) follow-up was performed. Patient demographic, clinical, and outcome variables were compared between SL angles less than 70° (cohort 1) and SL angles 70° or greater (cohort 2). Radiographic parameters were measured and recorded at 3 time points: baseline in the contralateral wrist, following closed reduction but prior to surgical intervention, and at final follow-up. Outcomes collected included Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Modified Global Assessment of Function (mGAF), and a visual analog scale (VAS) for pain. RESULTS One hundred ninety-two patients were included. Of these 192 patients, cohort 1 (n = 110) was observed to have median (range) SL angles of 58° (42°-68°) and cohort 2 (n = 82) median (range) SL angles of 74.5° (70°-87°) after closed reduction. Cohort 2 had statistically significant increases in median SL angles from closed reduction to final follow-up (74.5° [range, 70°-87°) to 78.5° (range, 71°-107°). There were no statistically significant differences in QuickDASH disability scores, mGAF scores, and VAS pain scores between the cohorts at initial and final follow-ups. CONCLUSIONS Patient-reported outcomes at 12 and 24 months do not differ between patients without radiographically apparent SL ligament injury (SL angles < 70°) and patients with radiographically apparent SL ligament injury(SL angles ≥ 70°) who do not undergo ligament repair or reconstruction following treatment of their intra-articular DRF. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Kevin M Klifto
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, Durham, NC
| | - Rachel E Hein
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, Durham, NC
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, Durham, NC
| | - Tyler S Pidgeon
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, Durham, NC
| | - Marc J Richard
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, Durham, NC
| | - David S Ruch
- Department of Orthopaedic Surgery, Division of Hand Surgery, Duke University School of Medicine, Durham, NC.
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Cha SM, Shin HD, Lee SH, Ga IH. Factors predictive for union of basal fracture of the ulnar styloid process after distal radial fracture fixation using a volar locking plate. Injury 2021; 52:524-531. [PMID: 33268076 DOI: 10.1016/j.injury.2020.10.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/11/2020] [Accepted: 10/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Some basal ulnar styloid fractures (USFs) achieve union without surgical fixation when accompanying distal radius fractures (DRFs) are treated via placement of volar locking plates (VLPs). The purpose of this study was to seek factors predictive of such healing through the retrospective case-control study. METHODS We evaluated 203 patients who received VLPs to treat DRFs in our institute from March 2010 to February 2018; Group 1 contained "union" patients and Group 2 contained "nonunion" patients. Basic demographic, radiological, and operative variables were compared. At the final follow-up (at least 2 years postoperatively), pain was scored using a visual analog scale (VAS). Scores on the Disabilities of the Arm, Shoulder, and Hand (DASH) instrument; grip strengths; and demerit points of the Gartland and Werley system were compared between groups. RESULTS Group 1 consisted of 58 patients and Group 2 consisted of 147 patients. Univariate analysis showed that age, bone mineral density (BMD), and Gaulke USF classification significantly differed between groups (all p < 0.05). Multivariate analysis showed that BMD (p < 0.001, odds ratio [OR] = 0.214, 95% confidence interval [95% CI] = 0.126-0.363) and Gaulke classification (p < .001, OR = 0.092, 95% CI = 0.034-0.250) were significantly associated with USF union, which was significantly higher in patients with mean BMD ≥ -0.12 (the cutoff value) and type IIC USFs. However, postoperative clinical outcomes at the final follow-up did not differ significantly between groups (all p > 0.05). CONCLUSIONS Approximately 30% (58/205) of basal USFs associated with DRFs united after VLPs alone were placed to treat the DRFs. BMD ≥ -0.12 independently predicted union. Type IIC USFs exhibited more union than other fracture types. Additional surgical fixation of a basal USF accompanied by a DRF treated via VLP placement may be unnecessary, especially if BMD is good and fracture type is IIC. LEVEL OF EVIDENCE Level III, Case-control study.
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Affiliation(s)
- Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
| | - Seung Hoo Lee
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - In Ho Ga
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
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Rosado EG, Olivella G, Natal-Albelo EJ, Echegaray GJ, Rivera LL, Guevara CA, Alejandro LM, Martínez-Rivera A, Ramírez N, Foy CA. Practice Variation Among Hispanic American Orthopedic Surgeons in the Management of Geriatric Distal Radius Fracture. Geriatr Orthop Surg Rehabil 2020; 11:2151459320969378. [PMID: 33282446 PMCID: PMC7683847 DOI: 10.1177/2151459320969378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction There is a controversy in the management of distal radius fractures (DRF) and its criteria for surgical intervention on geriatric patients. The American Academy of Orthopedic Surgeons (AAOS) developed evidence-based guidelines for treatment of DRF. The aim of this study was to evaluate the current practice of Hispanic orthopedic surgeons in the management of geriatric DRF and examine their adherence to AAOS guidelines based on years of surgical experience. Material & Methods A survey was emailed to all orthopedic surgeons who live in Puerto Rico and treated DRF in their daily practice. Responses concerning demographic, management and clinical scenarios were evaluated. For each clinical scenario, treatment of choice was selected with the same fracture in a geriatric and young adult patient. Comparison between years of surgical experience and adherence to the AAOS guidelines was performed. Results A total of 65 surgeons responded the survey with 65% having >15 years in practice. A high consensus with AAOS guidelines for DRF was found. Use of preoperative radiographs was reported in all respondents, with an additional 12% routine use of preoperative computed tomography scans. Seventy-seven percent of respondents did not allow any range of motion (ROM) at immediate postoperative period, while 23% allowed active or passive ROM. Use of postoperative therapy was reported in 72.3%. Correlation between years of surgical experience showed a higher use of Vitamin C postoperatively for prophylaxis of Complex Regional Pain Syndrome among surgeons <15 years (P = 0.01). A general consensus trend toward operative fixation was noted among geriatric and young adult patients with the same fracture type in all clinical scenarios. Discussion and Conclusions This survey demonstrates a practice variation toward surgical management of geriatric DRF among Hispanic orthopedic surgeons; despite their compliance with the AAOS AUC guidelines. The geriatric DRF management does not vary significantly among years of surgical experience.
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Affiliation(s)
- Edwin G Rosado
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Gerardo Olivella
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Eduardo J Natal-Albelo
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Gabriel J Echegaray
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Lenny L Rivera
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Carlos A Guevara
- Medicine Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Larry M Alejandro
- Medicine Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Arnaldo Martínez-Rivera
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Norman Ramírez
- Pediatric Orthopaedic Surgery Department, Mayagüez Medical Center, Mayagüez, Puerto Rico
| | - Christian A Foy
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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Stirling PHC, Oliver WM, Ling Tan H, Brown IDM, Oliver CW, McQueen MM, Molyneux SG, Duckworth AD. Patient-reported outcomes after corrective osteotomy for a symptomatic malunion of the distal radius. Bone Joint J 2020; 102-B:1542-1548. [PMID: 33135431 DOI: 10.1302/0301-620x.102b11.bjj-2020-0848.r3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The primary aim of this study was to describe patient satisfaction and health-related quality of life (HRQoL) following corrective osteotomy for a symptomatic malunion of the distal radius. METHODS We retrospectively identified 122 adult patients from a single centre over an eight-year period who had undergone corrective osteotomy for a symptomatic malunion of the distal radius. The primary long-term outcome was the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcomes included the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, the EQ-5D-5L score, complications, and the Net Promoter Score (NPS). Multivariate regression analysis was used to determine factors associated with the PRWE score. RESULTS Long-term outcomes were available for 89 patients (72%). The mean age was 57 years (SD 15) and 68 were female (76%). The median time from injury to corrective osteotomy was nine months (interquartile range (IQR) 6 to 13). At a mean follow-up of six years (1 to 11) the median PRWE score was 22 (IQR 7 to 40), the median QuickDASH score was 11.4 (IQR 2.3 to 31.8), and the median EQ-5D-5L score was 0.84 (IQR 0.69 to 1). The NPS was 69. Multivariate regression analysis showed that the presence of an associated ulnar styloid fracture was the only significant independent factor associated with a worse PRWE score when adjusting for confounding variables (p = 0.004). CONCLUSION We found that corrective osteotomy for malunion of the distal radius can result in good functional outcomes and high levels of patient satisfaction. However, the presence of an ulnar styloid fracture may adversely affect function. Level of Evidence: III (cohort study). Cite this article: Bone Joint J 2020;102-B(11):1542-1548.
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Affiliation(s)
- Paul H C Stirling
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William M Oliver
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Huai Ling Tan
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Iain D M Brown
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Christopher W Oliver
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Margaret M McQueen
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | - Sam G Molyneux
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew D Duckworth
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
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Tomori Y, Nanno M, Takai S. The Presence and the Location of an Ulnar Styloid Fracture Associated With Distal Radius Fracture Predict the Presence of Triangular Fibrocartilage Complex 1B Injury. Arthroscopy 2020; 36:2674-2680. [PMID: 32502711 DOI: 10.1016/j.arthro.2020.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the correlation between ulnar styloid fracture (USF) associated with distal radius fracture (DRF) and triangular fibrocartilage complex (TFCC) injuries and to elucidate whether the presence or location of an USF in a patient with DRF predicts the presence of traumatic TFCC injuries. METHODS From 2005 to 2018, an arthroscopic evaluation was performed to detect TFCC injuries associated with DRF. The presence and location of USFs were evaluated using computed tomography. TFCC injuries were classified in accordance with Palmer's classification. All wrists were divided into group A (DRF without USF) and group B (DRF with USF). The incidence of TFCC injuries in the 2 groups was compared. group B was then divided into 2 subgroups in accordance with the USF location: the tip or middle fracture subgroup and the base fracture subgroup. Data were analyzed with significance set at P < .05. RESULTS One hundred thirty-eight patients were enrolled in this study. Group A included 42 wrists in 42 patients, whereas group B included 96 wrists in 96 patients. There were significant differences between the 2 groups regarding the incidence of traumatic TFCC injuries (P = .036) and TFCC 1B injury (P = .002), although there were no differences between the 2 groups regarding age, sex, injured side, direction of displacement, and type of DRF. Within group B, the tip and middle fracture subgroup included 37 wrists in 37 patients, whereas the base fracture group included 59 wrists in 59 patients; a significant difference was observed between the two subgroups regarding the incidences of TFCC 1B injuries (P = .044). CONCLUSIONS The presence of USF associated with DRF predicted the presence of frequently occurring traumatic TFCC injury and TFCC 1B injury. Moreover, the location of USFs was a predictive factor for TFCC 1B injury in adults with DRF. On the other hand, traumatic TFCC injury had occurred in adults with DRF, regardless of the presence of USF. LEVEL OF EVIDENCE Level IV, Case series.
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Affiliation(s)
- Yuji Tomori
- Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan.
| | - Mitsuhiko Nanno
- Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School Hospital, Tokyo, Japan
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Chen ACY, Lin YH, Weng CJ, Cheng CY. Surgical management of ulnar styloid fractures: comparison of fixation with anchor suture and tension band wire. J Orthop Surg Res 2020; 15:273. [PMID: 32693819 PMCID: PMC7372894 DOI: 10.1186/s13018-020-01795-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited reference is available regarding surgical management in symptomatic ulnar styloid fractures with small bony avulsion. The study goal is to report the surgical outcomes using anchor suture fixation with comparison to traditional tension band wire fixation. METHODS We retrospectively reviewed the medical records in patients who underwent surgical repair for unilateral ulnar styloid fractures with distal radioulnar instability between 2004 and 2017. A total of 31 patients were enrolled including two kinds of fixation methods. Anchor suture fixation plus distal radioulnar joint pinning was performed in ten patients with tiny avulsion bony fragments (group A); tension band wire fixation was performed in 21 patients with big styloid fracture fragments (group B). Patient characteristics and 2-year treatment outcomes were compared between two groups based on Mayo Modified Wrist Score (MMWS); Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH); visual analog scale (VAS), and surgical complication. Descriptive statistics were used for calculation of key variables; a p value of < 0.05 was considered statistically significant. RESULTS Based on Gaulke classification, there were five subtypes in group A and three subtypes in group B. Incidence of concomitant distal radius fractures was significantly higher in group B; other patient characteristics including age, sex, injury side, and time to surgery showed no significant difference. Outcome assessment regarding MMWS, QuickDASH, and VAS was comparable between two groups. Bone-related complications including nonunion, DRUJ subluxation, and styloid resorption were analyzed; the difference was not significant. Incidence of implant-related complications including migration and secondary removal surgery was significantly higher in group B (p = 0.021). CONCLUSION Surgical fixation in symptomatic ulnar styloid fractures yields comparable treatment outcomes in both fracture patterns. Implant-related complication with secondary removal surgery is more common in tension band wire group. Anchor suture fixation is a feasible option for tiny styloid avulsion fragments with limited surgical complication.
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Affiliation(s)
- Alvin Chao-Yu Chen
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and Chang Gung University College of Medicine, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China.
| | - Yi-Hsuan Lin
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and Chang Gung University College of Medicine, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China
| | - Chun-Jui Weng
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and Chang Gung University College of Medicine, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China
| | - Chun-Ying Cheng
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and Chang Gung University College of Medicine, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China
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Radiographic Measurements as a Predictor of Correction Loss in Conservative Treatment of Colles' Fracture. J UOEH 2019; 41:139-144. [PMID: 31292357 DOI: 10.7888/juoeh.41.139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Dorsal displaced distal radius fracture (Colles' fracture) is very common and could occur from fragility in middle-aged and elderly people. Many Colles' fractures are still treated conservatively in clinics without hospitalization. Internal fixation using a palmar locking plate has been the standard treatment, but some complications have been reported. The aim of this study was to analyze changes in radiographic parameters over time in patients with conservatively treated Colles' fractures, and to establish whether the type of fracture influenced these changes. Prospective data collected included patient characteristics and radiological findings. The study was conducted at two private clinics and included 60 patients (13 men and 47 women; mean age, 72.5 years old; range, 55 to 96 years old) with a Colles' fracture (types of injury: intramedullary [n = 15], anatomical [n = 39], extramedullary [n = 2], and unknown [n = 4]) who were treated conservatively with manipulation and cast immobilization. Conservative, non-surgical treatment with manipulation was performed first, then, cast immobilization continued for 4 weeks. Loss of correction between the time of reduction and the final observation was defined by the following radiographic measurements: palmar tilt, radial inclination, and ulnar variance. The average final follow up period was 4.6 months (1.5-12 months). Immediately after reduction, 11 intramedullary fractures, 42 anatomical fractures and 7 extramedullary fractures were confirmed. Correction loss according to ulnar variance was significantly greater (P = 0.012) during the final observation for patients with an intramedullary injury at reduction than that for patients with extramedullary and anatomical injuries at reduction. We found that the correction loss for ulnar variance from immediately after reduction until the final observation was significantly greater in the intramedullary group, suggesting that an alternative to conservative treatment may be beneficial for patients with intramedullary fractures.
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Korhonen L, Victorzon S, Serlo W, Sinikumpu JJ. Non-union of the ulnar styloid process in children is common but long-term morbidity is rare: a population-based study with mean 11 years (9-15) follow-up. Acta Orthop 2019; 90:383-388. [PMID: 30945579 PMCID: PMC6718181 DOI: 10.1080/17453674.2019.1596561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Fracture of the ulnar styloid process (USP) is common in children in connection with distal radius fracture. The long-term morbidity of USP non-union following a childhood distal radius fracture is unclear. We evaluated long-term clinical and radiographic findings of USP non-union. Patients and methods - All 208 children (< 16 years) who had suffered from distal radius fracture with or without a diagnosed concomitant ulnar fracture during 1992-1999 in the study institution were invited to follow-up at mean of 11 years (9-15) after the injury. Radiographs of both wrists of all 139 participants (67%) were taken; 22 patients showed USP non-union and they made up the study population. Distal radioulnar joint (DRUJ) instability, decreased range of motion (ROM), and weakened grip strength as compared with the uninjured side were the main functional outcomes. Elements of the "Disability of Arm, Shoulder and Hand" questionnaire were used for subjective symptoms. Results - The rate of USP non-union following childhood distal forearm fracture was 16% (22/139) and only 9 of the ulnar styloid fractures were visible in the radiographs primarily. At follow-up wrist flexion-extension ROM and ulnar and radial deviation ranges did not differ between the injured and uninjured sides. Grip strengths were similar. 6 patients reported pain during exercise. 7 had ulna minus (mean 2.3 mm) but none showed degenerative radiographic findings. Interpretation - The long-term clinical results of USP non-union following a childhood wrist fracture were good. However, one-third of the patients with USP non-union had ulnar shortening, which may predispose them to degenerative processes later in life.
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Affiliation(s)
- Linda Korhonen
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu;; ,Medical Research Centre Oulu; PEDEGO Research Group; Oulu Childhood Fracture and Sports Injury Study; University of Oulu, Oulu;; ,Correspondence:
| | | | - Willy Serlo
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu;; ,Medical Research Centre Oulu; PEDEGO Research Group; Oulu Childhood Fracture and Sports Injury Study; University of Oulu, Oulu;;
| | - Juha-Jaakko Sinikumpu
- Department of Children and Adolescents, Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu;; ,Medical Research Centre Oulu; PEDEGO Research Group; Oulu Childhood Fracture and Sports Injury Study; University of Oulu, Oulu;;
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Cheema AN, Dardas AZ, Hast MW, Gray BL. The effects of incremental ulnar styloid osteotomies on distal radioulnar joint stability: a biomechanical cadaveric study. J Hand Surg Eur Vol 2019; 44:510-516. [PMID: 30871405 DOI: 10.1177/1753193419834858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to systematically quantify distal radioulnar joint stability with a cadaveric model, using radiographic and joint contact force measurements. Six fresh-frozen cadavers underwent sequential ulnar styloid osteotomies. Posteroanterior and lateral stress radiographs were obtained and joint contact forces and areas were measured. Posteroanterior radiographs showed a significant increase in the distal radioulnar joint gap after osteotomy of the base of the ulnar styloid. Contact force and contact area measurements were not significantly different. We conclude that fractures that involve the ulnar styloid base should be considered for operative fixation when carrying out open reduction and internal fixation of fractures of the distal radius.
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Affiliation(s)
- Adnan N Cheema
- 1 Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Agnes Z Dardas
- 1 Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael W Hast
- 2 University of Pennsylvania, Biedermann Lab for Orthopaedic Research, Philadelphia, PA, USA
| | - Benjamin L Gray
- 1 Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Achten J, Sones W, Dias J, Hedley H, Cook JA, Dritsaki M, Png ME, Gray A, Lamb SE, Costa ML. Surgical fixation with K-wires versus plaster casting in the treatment of dorsally displaced distal radius fractures: protocol for Distal Radius Acute Fracture Fixation Trial 2 (DRAFFT 2). BMJ Open 2019; 9:e028474. [PMID: 30904879 PMCID: PMC6475232 DOI: 10.1136/bmjopen-2018-028474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Optimal management of distal radius fractures in adults remains controversial. Previous evidence and current clinical guidelines tell us that, if a closed reduction of a dorsally displaced fracture is possible, Kirschner wires (K-wires) are the preferred form of surgical fixation. However, the question remains whether there is any need to perform surgical fixation following a successful closed reduction, or is a simple plaster cast as effective? This is the protocol for a randomised controlled trial of manipulation and surgical fixation with K-wires versus manipulation and casting in the treatment of dorsally displaced distal radius fractures. METHODS AND ANALYSIS Adult patients with an acute dorsally displaced fracture of the distal radius are potentially eligible to take part. Prior to surgery, baseline demographic data, radiographs, data on pain/function using the Patient-Rated Wrist Evaluation Score (PRWE) and health-related quality of life (HRQoL) using the EuroQoL 5-dimension 5-level (EQ-5D-5L) will be collected. A randomisation sequence, stratified by centre, intra-articular extension of the fracture and age, will be administered via a secure web-based service. Each patient will be randomly allocated to either 'manipulation and surgical fixation with K-wires' or 'manipulation and plaster casting'. A clinical assessment, radiographs and records of early complications will be recorded at 6 weeks. PRWE and HRQoL outcome data will be collected at 3, 6 and 12 months post-randomisation. Further information will be requested with regard to healthcare resource use and any complications. ETHICS AND DISSEMINATION The National Research Ethic Committee approved this study on 6 October 2016 (16/SC/0462).The National Institute for Health Research Health Technology Assessment monograph and a manuscript to a peer-reviewed journal will be submitted on completion of the trial. The results of this trial will substantially inform clinical practice on the clinical and cost-effectiveness of the treatment of this injury. TRIAL REGISTRATION NUMBER ISRCTN11980540; Pre-results.
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Affiliation(s)
- Juul Achten
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - William Sones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Joseph Dias
- Department of Orthopedics, Leicester General Hospital, Leicester, UK
| | - Helen Hedley
- Department of Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jonathan A Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Melina Dritsaki
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - May Ee Png
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alastair Gray
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Matthew L Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Kuloor S, Shareef A. Distal radius fractures with unstable distal radioulnar joint treated by volar plate: A comparative study of immobilization versus early mobilization. JOURNAL OF ORTHOPAEDICS AND SPINE 2019. [DOI: 10.4103/joas.joas_6_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pedrazzini A, Bastia P, Bertoni N, Pedrabissi B, Simo HCY, Medina V, Ceccarelli F, Pogliacomi F. Distal radius nonunion after epiphyseal plate fracture in a 15 years old young rider. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 90:169-174. [PMID: 30715019 PMCID: PMC6503422 DOI: 10.23750/abm.v90i1-s.7999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Radius and ulna fractures are the most common long bone fractures in children and adolescents. The majority of these injuries involve the distal metaphyseal portion of the radius associated or not to physeal plate injuries. Because of the high remodelling potential of the distal radius in growing children most injuries heal without complication after closed reduction and immobilization in a long arm cast. Nonunions of closed distal radius fracture are an extremely rare occurrence especially in paediatric population. Methods: In this report, we describe a rare case of distal radius fracture nonunion in a 15-years old male rider treated conservatively with cast immobilization. Eight months later he underwent surgical closed reduction and fixation with kirschner wire and cannulated screw. Results: Follow-up at 2 years showed satisfying radiological and functional outcomes. The patient ultimately returned to ride 3 months following surgery. Conclusions: Nonunion is rarely seen in distal radius fractures in healthy children and adolescents, and there are few studies in the literature. Treatment of the nonunion must be individualized and the results are not entirely predictable.
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Nagura N, Naito K, Zemirline A, Sugiyama Y, Kinoshita M, Goto K, Iwase Y, Kaneko K. Volar dislocation of the ulnar head after distal radial fracture: Case report and review of the pertinent literature. Ann Med Surg (Lond) 2018; 35:185-188. [PMID: 30364754 PMCID: PMC6197738 DOI: 10.1016/j.amsu.2018.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction We report the case of volar dislocation of the ulnar head occurred after osteosynthesis for the treatment of distal radius fracture. Presentation of case The patient, 68-year-old female, had the dorsal displaced left distal radius fracture and volar dislocation of the ulnar head. Osteosynthesis was performed using a volar locking plate without postoperative immobilization. Two weeks after surgery, volar dislocation of the ulnar head in distal radioulnar joint (DRUJ) was noted on CT. Re-operation, triangular fibrocartilage complex (TFCC) was sutured to the ulnar fovea using a suture anchor, was performed in order to stabilize DRUJ. At 24 months after surgery, left wrist joint pain and the range of motion have improved, and the Mayo wrist score was excellent. Discussion Based on the fact that the radius was fractured and the ulna was dislocated in DRUJ at the time of injury, the present case may have been a Galeazzi fracture. Conclusion When distal radius fracture is complicated by ulnar instability of DRUJ, active repair of the TFCC function may be necessary to prevent residual postoperative instability.
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Affiliation(s)
- Nana Nagura
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Kiyohito Naito
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ahmed Zemirline
- Hand Center of Brittany, St Grégoire Private Hospital Center, 6 Boulevard de la Boutière, 35760, Saint-Grégoire, France
| | - Yoichi Sugiyama
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mayuko Kinoshita
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kenji Goto
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yoshiyuki Iwase
- Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Abboudi J, Sandilands SM, Hoffler CE, Kirkpatrick W, Emper W. Technique for Intramedullary Stabilization of Ulnar Neck Fractures. Hand (N Y) 2018; 13:563-571. [PMID: 28877600 PMCID: PMC6109907 DOI: 10.1177/1558944717725376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Distal ulna fractures at the ulnar neck can be seen in association with distal radius fractures, and multiple techniques have been described to address the ulnar neck component of these injuries. We have found that treatment of ulnar neck fractures can be challenging in terms of anatomy and fracture fixation. We present a new percutaneous fixation technique for ulnar neck fractures commonly seen with distal radius fractures. TECHNIQUE Fixation of the ulnar neck fracture is performed after fixation of the distal radius fracture. Our technique uses anterograde intramedullary fixation to stabilize the fracture with a 1.6-mm (0.062 inch) Kirschner wire or a commercially available metacarpal fixation intramedullary nail. The fixation is introduced into the intramedullary space of the ulnar shaft 4 to 6 cm proximal to the fracture at a separate surgical site along the subcutaneous border of the ulna. The fixation is also supported with a sugar-tong splint for the first few weeks after surgery and requires removal of the ulnar implant approximately 10 weeks after implantation. CONCLUSION Our technique utilizes a percutaneous approach with minimal fracture exposure. It provides a relatively simple and reproducible method to address ulnar neck fractures commonly seen in association with distal radial fractures.
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Affiliation(s)
- Jack Abboudi
- Rothman Institute, Philadelphia, PA, USA,Jack Abboudi, 3855 West Chester Pike, Suite 340, Newtown Square, PA 19073, USA.
| | | | | | - William Kirkpatrick
- Rothman Institute, Philadelphia, PA, USA,Thomas Jefferson University, Philadelphia, PA, USA
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Chen ACY, Chiu CH, Weng CJ, Chang SS, Cheng CY. Early and late fixation of ulnar styloid base fractures yields different outcomes. J Orthop Surg Res 2018; 13:193. [PMID: 30064441 PMCID: PMC6069711 DOI: 10.1186/s13018-018-0899-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
Background The role of surgical fixation of ulnar styloid fractures remains a subject of debate. The purpose of this study was to compare the surgical outcomes following early and late intervention. Methods We retrospectively reviewed 28 patients who underwent surgical repair for unilateral ulnar styloid fractures with distal radioulnar instability between 2004 and 2014. Surgical fixation was performed within 3 months of injury in 13 patients (group A) and beyond 3 months in 15 patients (group B). Patient characteristics and functional outcomes were compared between the two groups. The outcome survey consisted of QuickDASH score, grip strength, range of motion, pain score based on the visual analog scale, and surgical complications. Descriptive statistics were calculated for key variables. A p value of < 0.01 was considered statistically significant. Results Patient characteristics including age, sex, injured side, dominant side injury, and concomitant distal radius fracture showed no significant differences between the two groups. Time to surgery averaged 1.1 months in group A and 12.3 months in group B. Significantly better outcomes were found in group A than in group B, including QuickDASH scores (4.4 ± 5.9 vs. 12.9 ± 9.9) and grip strength (37.4 ± 5.1 vs. 29.1 ± 5.9 kg). Significantly better range of motion was found in group A than in group B with respect to supination (81.9° ± 4.3° vs. 75° ± 8.5°), extension (84.6 ± 4.3 vs. 76.7 ± 6.5), and flexion (80.4° ± 3.8° vs. 72° ± 4.1°). The difference was not significant in case of pronation (78.8° ± 3° vs. 74.3° ± 5.9°) and with respect to pain scores (0.6 ± 0.7 vs. 1.3 ± 1). Conclusion Both osseous and soft tissue lesions need to be fully addressed in ulnar styloid fractures. Early detection and surgical repair yielded better outcomes. Higher complication rates in late-treated fractures show that surgeons should select surgical candidates and modalities properly.
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Affiliation(s)
- Alvin Chao-Yu Chen
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and Chang Gung University College of Medicine, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China.
| | - Chih-Hao Chiu
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and Chang Gung University College of Medicine, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China
| | - Chun-Jui Weng
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and Chang Gung University College of Medicine, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China
| | - Shih-Sheng Chang
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and Chang Gung University College of Medicine, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China
| | - Chun-Ying Cheng
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and Chang Gung University College of Medicine, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China
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Almedghio S, Arshad MS, Almari F, Chakrabarti I. Effects of Ulnar Styloid Fractures on Unstable Distal Radius Fracture Outcomes: A Systematic Review of Comparative Studies. J Wrist Surg 2018; 7:172-181. [PMID: 29576925 PMCID: PMC5864499 DOI: 10.1055/s-0037-1607214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
Purpose In this literature review, functional outcomes such as Disability of Arm, Shoulder and Hand (DASH) score and the visual analog scale (VAS) of pain along with clinical outcomes such as range of movement and grip strength of treated distal radius fractures (DRF) accompanied with ulnar styloid fractures (USF) will be compared with those with isolated DRF. Materials and Methods We analyzed articles from MEDLINE, Embase, and CINAHL that met our predetermined inclusion and exclusion criteria as per the Preferred Reporting Items for Systematic Reviews and Meta-analysis statements. This resulted in the identification of 464 articles with 18 potentially eligible studies of which 6 were included at the full-text screening stage. The primary outcomes were wrist pain, range of motion, functional outcome and satisfaction, such as VAS, and the DASH questionnaire along with radiological assessment and incidence of complications. Results These studies involved 796 participants with DRF and 806 wrists with DRF; 444 (55%) of DRF had an associated USF. Three studies did not report any statistically significant difference in DASH scores between the DRF patients with or without USF. Two studies reported worse DASH scores in the group with associated USF. Wrist pain was reported to be statistically significantly worse in patients with associated USF in two studies. Grip strength did not exhibit a statistically significant difference in any groups in four studies. On assessing the range of motion of the wrist and forearm, only one study reported a statistically significant difference in flexion at 2 years follow-up, with less flexion in patients with USF. Conclusion This review suggests that there is no significant correlation between a USF and the functional and clinical outcomes of DRF treatment, albeit wrist pain and less flexion were reported in some studies to be associated with USF. There is a need for more robust evidence from large randomized controlled trials to specifically look at the effects of fixation versus nonfixation of USF on DRF, or large prospective cohort studies assessing DRF with and without USF, with a minimum of 12 months follow-up. Level of Evidence Level II-therapeutic.
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Affiliation(s)
- Sami Almedghio
- Department of Trauma and Orthopaedics, Dr Gray's Hospital, NHS Grampian, Elgin, United Kingdom
| | - Mohammed Shoaib Arshad
- Department of Trauma and Orthopaedics, Pennine Acute Hospitals NHS Trust, Royal Oldham Hospital, Oldham, United Kingdom
| | - Fayez Almari
- Department of Trauma and Orthopaedics, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Indranil Chakrabarti
- Department of Trauma and Orthopaedics, Rotherham NHS Foundation Trust, Rotherham, United Kingdom
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The status of triangular fibrocartilage complex after the union of distal radius fractures with internal plate fixation. INTERNATIONAL ORTHOPAEDICS 2018; 42:1917-1922. [PMID: 29476211 DOI: 10.1007/s00264-018-3793-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/19/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Distal radius fractures are associated with a high incidence of triangular fibrocartilage complex (TFCC) tears. This study aims to evaluate the status of TFCC after the healing of distal radius fractures, and its clinical significance. METHODS Wrist arthroscopies were performed on 43 distal radius fractures, with an average age of 54 years old. RESULTS Twenty-six complete tears and 15 partial healed tears were noted. Five out of eight patients with intact TFCC tears had neither signs nor symptoms, while eight patients with TFCC tears had no complaint. While no association was found between ulnar wrist pain and TFCC tears, there was association between DRUJ instability and TFCC tears and fovea tears. The function outcome did not differ with respect to the integrity of TFCC. CONCLUSIONS A large majority of TFCC tears remained unhealed after the union of distal radius fractures. However, not all patients with tear were symptomatic.
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Mulders MAM, Fuhri Snethlage LJ, de Muinck Keizer RJO, Goslings JC, Schep NWL. Functional outcomes of distal radius fractures with and without ulnar styloid fractures: a meta-analysis. J Hand Surg Eur Vol 2018; 43:150-157. [PMID: 28931338 PMCID: PMC5791517 DOI: 10.1177/1753193417730323] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The aim of this meta-analysis was to compare the functional outcomes of patients with a distal radius fracture with and without a concomitant fracture of the ulnar styloid process. A systematic literature search was performed to identify all studies comparing patients with a distal radius fracture with and without an ulnar styloid process fracture. The initial search revealed 511 articles, of which 12 articles with a total of 2243 patients were included; 1196 patients with and 1047 patients without an ulnar styloid process fracture. A statistically significant mean difference of 3.40 points (95% CI 1.33-5.48) in the Disability of the Arm, Shoulder, and Hand score was found in favour of patients without an ulnar styloid process fracture. This difference is less than 10 and therefore not clinically important. No significant difference was found in Patient-Rated Wrist Evaluation scores, range of motion, grip strength, visual analogue scale pain scores, ulnar-sided wrist pain and distal radio-ulnar joint instability between patients with and without an ulnar styloid process fracture after 1 year of follow-up. Moreover, no significant differences were found between ulnar styloid base and nonbase fractures. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Marjolein A. M. Mulders
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands,Marjolein A. M. Mulders, Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | | | | | - J. Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Niels W. L. Schep
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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Pidgeon TS, Crisco JJ, Waryasz GR, Moore DC, DaSilva MF. Ulnar Styloid Base Fractures Cause Distal Radioulnar Joint Instability in a Cadaveric Model. Hand (N Y) 2018; 13:65-73. [PMID: 28718315 PMCID: PMC5755858 DOI: 10.1177/1558944716685830] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The deep portion of the distal radioulnar ligaments (DRUL) inserts on the ulnar fovea and is the most important stabilizer of the distal radioulnar joint (DRUJ). Ulnar styloid base fractures that include the ulnar fovea may cause DRUJ instability. METHODS DRUJ stability in pronosupination was evaluated in 12 fresh-frozen upper extremities (4 female) aged 52 to 68 years (mean: 58.8 years) using a custom fixture, which allowed free rotation of the radius around the fixed ulna. Optical motion capture was used to record rotation of the radius with respect to the ulna. Each specimen was subjected to 3 N m of torque in both supination and pronation under 4 conditions: intact, ulnar styloid osteotomy with disruption of the foveal insertion of the DRUL, ulnar styloid fixation, and DRUL transection. Group differences were compared using a 1-way repeated-measures analysis of variance and Tukey multiple comparison post hoc tests. RESULTS When compared with the intact condition, both ulnar styloid osteotomy and DRUL transection significantly increased mean pronation (by 9.40° and 15.21°, respectively) and supination (by 9.05° and 17.42°, respectively) of the forearm. Screw fixation only significantly reduced pronation compared with osteotomy (by 2.62°). Screw fixation did not significantly affect supination. CONCLUSIONS Ulnar styloid fractures that disrupt the fovea cause instability of the DRUJ in pronation and supination under 3 N m of torque in a cadaveric model. Screw fixation of ulnar styloid base fractures achieves anatomic reduction; however, it only partially returns rotational stability acutely to the DRUJ and only during pronation.
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Affiliation(s)
- Tyler S. Pidgeon
- The Warren Alpert Medical School of Brown University, Providence, RI, USA,Tyler S. Pidgeon, Department of Orthopaedics, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, 2 Dudley Street, Suite 200, Providence, RI 02905, USA.
| | - Joseph J. Crisco
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Gregory R. Waryasz
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Douglas C. Moore
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Manuel F. DaSilva
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Stinton SB, Graham PL, Moloney NA, Maclachlan LR, Edgar DW, Pappas E. Longitudinal recovery following distal radial fractures managed with volar plate fixation. Bone Joint J 2017; 99-B:1665-1676. [PMID: 29212691 DOI: 10.1302/0301-620x.99b12.bjj-2017-0348.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 07/18/2017] [Indexed: 12/27/2022]
Abstract
AIMS To synthesise the literature and perform a meta-analysis detailing the longitudinal recovery in the first two years following a distal radius fracture (DRF) managed with volar plate fixation. MATERIALS AND METHODS Three databases were searched to identify relevant articles. Following eligibility screening and quality assessment, data were extracted and outcomes were assimilated at the post-operative time points of interest. A state-of-the-art longitudinal mixed-effects meta-analysis model was employed to analyse the data. RESULTS The search identified 5698 articles, of which 46 study reports met the selection criteria. High levels of disability and impairment were reported in the immediate post-operative period with subsequently a rapid initial improvement followed by more gradual improvement for up to one year. The results highlight that the period associated with the greatest physical recovery is in the first three months and suggest that the endpoint of treatment outcomes is best measured at one year post-surgery. CONCLUSION Clinically meaningful improvements in outcomes can be expected for 12 months, after which progress plateaus and reaches normal values. This paper adopted a novel approach to meta-analyses in that the research question was of a longitudinal nature, which required a unique method of statistical analysis. Cite this article: Bone Joint J 2017;99-B:1665-76.
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Affiliation(s)
- S B Stinton
- Arthritis and Musculoskeletal Research Group, The University of Sydney, 75 East St, O204, Lidcombe NSW 2141, Australia, and Westmead Private Physiotherapy Services, 16 Mons Rd, Westmead NSW 2145, Australia
| | - P L Graham
- Macquarie University, 12 Wally's Walk, Building E7A, Level 6, Macquarie University, NSW 2109, Australia
| | - N A Moloney
- Macquarie University, 75 Talavera Road, Macquarie Park, NSW 2113, Australia
| | - L R Maclachlan
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia QLD 4072, Australia
| | - D W Edgar
- Fiona Stanley Hospital, Fiona Wood Foundation and The University of Notre Dame Australia, 11 Robin Warren Drive, Murdoch, WA 6150, Australia, Fiona Wood Foundation, 102-118 Murdoch Drive, Murdoch, WA 6150, Australia, and The University of Notre Dame Australia, 19 Mouat Street, Fremantle WA 6160, Australia
| | - E Pappas
- Arthritis and Musculoskeletal Research Group, The University of Sydney, 75 East St, O204, Lidcombe NSW 2141, Australia
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Yuan C, Zhang H, Liu H, Gu J. Does concomitant ulnar styloid fracture and distal radius fracture portend poorer outcomes? A meta-analysis of comparative studies. Injury 2017; 48:2575-2581. [PMID: 28882374 DOI: 10.1016/j.injury.2017.08.061] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/10/2017] [Accepted: 08/27/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE An ulnar styloid fracture often occur in association with a distal radial fracture. Whether an ulnar styloid fracture interfere with the results of a distal radial fracture still remains controversial. The aim of this study was to analyse the effects of an accompanying ulnar styloid fracture on clinical outcomes in patients with distal radial fractures. METHODS A meta-analysis of published studies comparing outcomes of distal radial fractures with an ulnar styloid fracture versus isolated distal radial fractures was performed. Outcomes of function results, radiological evaluation, and patient reported scores were analyzed. RESULTS Ten studies including 1403 distal radius fractures were identified fitting inclusion criteria. There was no significant difference in wrist motion, grip strength, radial height, volar angle, ulnar variance, pain score, PRWE score, or SF-36 score for distal radial fractures associated with an ulnar styloid fracture versus isolated distal radial fractures. In final follow up, patients with associated an ulnar styloid fracture had lower radial inclination and higher DASH scores. But there was no significant clinical difference. In addition, we found there was no significant difference of outcomes between union and non-union ulnar styloid fractures. CONCLUSIONS Based on this meta-analysis, we suggest that an associated ulnar styloid fracture does not affect the outcomes of a distal radial fracture and clinicians should be caution in electing operative treatment for patients with an ulnar styloid fracture.
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Affiliation(s)
- Chaoqun Yuan
- Department of Hand Surgery, Subei People's Hospital, Address: NO. 98, West Nantong Road, Yangzhou 225000, China.
| | - Hanyu Zhang
- Department of Emergency Medicine, Subei People's Hospital, Address: NO. 98,West Nantong Road, Yangzhou 225000, China.
| | - Hongjun Liu
- Department of Hand Surgery, Subei People's Hospital, Address: NO. 98, West Nantong Road, Yangzhou 225000, China.
| | - Jiaxiang Gu
- Department of Hand Surgery, Subei People's Hospital, Address: NO. 98, West Nantong Road, Yangzhou 225000, China.
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Distal radioulnar joint instability. HAND SURGERY & REHABILITATION 2017; 36:305-313. [DOI: 10.1016/j.hansur.2017.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 07/06/2017] [Accepted: 08/01/2017] [Indexed: 11/22/2022]
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Baradaran A, Moradi A, Sadeghi R, Ebrahimzadeh MH. Do we underestimate the predictive value of the ulnar styloid involvement in distal radius fractures? A systematic review and meta-analysis of clinical studies. J Hand Surg Eur Vol 2017; 42:642-645. [PMID: 27558573 DOI: 10.1177/1753193416663671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A Baradaran
- 1 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - A Moradi
- 2 Department of Orthopedic Surgery, Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - R Sadeghi
- 3 Department of Nuclear Medicine, Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - M H Ebrahimzadeh
- 2 Department of Orthopedic Surgery, Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Nunez FA, Luo TD, Nunez FA. Treatment of symptomatic non-unions of the base of the ulnar styloid with plate osteosynthesis. J Hand Surg Eur Vol 2017; 42:382-388. [PMID: 26992415 DOI: 10.1177/1753193416638483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this prospective case series was to assess the efficacy of plate osteosynthesis using a low profile distal ulna plate for the management of persistently symptomatic non-unions of the base of the ulnar styloid. Six consecutive patients underwent resection of the non-union and plate osteosynthesis with a 2.0 mm distal ulna hook plate. Post-operative measurements of mean pain scores, QuickDASH scores, grip strength, and range of motion parameters showed significant improvements compared with the pre-operative values. No complications were reported at a mean follow-up of 25 months. The present study presents an alternative method for treating symptomatic ulnar styloid non-unions that provides stable fixation with low risk of implant removal. LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- F A Nunez
- 1 Wake Forest Baptist Medical Center, Medical Center Blvd, Winston Salem, NC, USA
| | - T D Luo
- 1 Wake Forest Baptist Medical Center, Medical Center Blvd, Winston Salem, NC, USA
| | - F A Nunez
- 2 Centro Medico Guerra Mendez, Valencia, Venezuela
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Jose A, Suranigi SM, Deniese PN, Babu AT, Rengasamy K, Najimudeen S. Unstable Distal Radius Fractures Treated by Volar Locking Anatomical Plates. J Clin Diagn Res 2017; 11:RC04-RC08. [PMID: 28274009 DOI: 10.7860/jcdr/2017/24114.9261] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 11/01/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Fracture of the distal end of radius represents the most common fracture of the upper extremity accounting for 16-20% of all fractures. Plating is now emerging as the gold standard for management of distal radius fractures due to increased rate of complications such as malunion, subluxation/dislocation of distal radio-ulnar joint or late collapse of fracture. Procedures such as closed reduction and cast immobilization, ligamentotaxis with external fixator and percutaneous pin fixation are no longer acceptable. AIM The purpose of the study was to evaluate the functional and radiological outcome of unstable distal radius fractures treated with the volar locking plate. MATERIALS AND METHODS We reviewed 53 patients from January 2011 to December 2015, treated for unstable distal radius fractures using a volar locking compression plate. Standard radiographic and clinical assessment after 12 months (range 12-16 months) were measured and final functional and radiological outcome were assessed using the Modified Mayo wrist scoring system and Sarmiento's modification of Lindstorm criteria respectively. RESULTS There were 42 males and 11 females with an average age of 39.12±31.78 years (18-71 years). At the end of 12 months, 36 patients had an excellent radiological outcome and 10 patients had good radiological outcome as per Sarmiento's modification of Lindstorm criteria. Eleven patients had an excellent functional outcome and 26 patients had a good functional outcome as per modified Mayo wrist scoring system. There was one case of superficial wound infection which subsided with intravenous antibiotics. CONCLUSION The volar locking plate fixation helps in early mobilization of the wrist, restores anatomy, allows early return to function, prevents secondary loss of reduction and hence is an effective treatment for unstable fractures of the distal radius.
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Affiliation(s)
- Anto Jose
- Resident, Department of Orthopaedics, Pondicherry Institute of Medical Sciences , Pondicherry, India
| | - Shishir Murugharaj Suranigi
- Associate Professor, Department of Orthopaedics, Pondicherry Institute of Medical Sciences , Pondicherry, India
| | - Pascal Noel Deniese
- Assistant Professor, Department of Orthopaedics, Pondicherry Institute of Medical Sciences , Pondicherry, India
| | - Abey Thomas Babu
- Assistant Professor, Department of Orthopaedics, Pondicherry Institute of Medical Sciences , Pondicherry, India
| | - Kanagasabai Rengasamy
- Professor, Department of Orthopaedics, Pondicherry Institute of Medical Sciences , Pondicherry, India
| | - Syed Najimudeen
- Professor and Head, Department of Orthopaedics, Pondicherry Institute of Medical Sciences , Pondicherry, India
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Faucher GK, Zimmerman RM, Zimmerman NB. Instability and Arthritis of the Distal Radioulnar Joint. JBJS Rev 2016; 4:01874474-201612000-00003. [DOI: 10.2106/jbjs.rvw.16.00005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Sawada H, Shinohara T, Natsume T, Hirata H. Clinical effects of internal fixation for ulnar styloid fractures associated with distal radius fractures: A matched case-control study. J Orthop Sci 2016; 21:745-748. [PMID: 27511887 DOI: 10.1016/j.jos.2016.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/12/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ulnar styloid fractures are often associated with distal radius fractures. However, controversy exists regarding whether to treat ulnar styloid fractures. This study aimed to evaluate clinical effects of internal fixation for ulnar styloid fractures after distal radius fractures were treated with the volar locking plate system. METHODS We used prospectively collected data of distal radius fractures. 111 patients were enrolled in this study. A matched case-control study design was used. We selected patients who underwent fixation for ulnar styloid fractures (case group). Three control patients for each patient of the case group were matched on the basis of age, sex, and fracture type of distal radius fractures from among patients who did not undergo fixation for ulnar styloid fractures (control group). The case group included 16 patients (7 men, 9 women; mean age: 52.6 years; classification of ulnar styloid fractures: center, 3; base, 11; and proximal, 2). The control group included 48 patients (15 men, 33 women; mean age: 61.1 years; classification of ulnar styloid fractures: center, 10; base, 31; and proximal, 7). For radiographic examination, the volar tilt angle, radial inclination angle, and ulnar variance length were measured, and the union of ulnar styloid fractures was judged. For clinical examination, the range of motions, grip strength, Hand20 score, and Numeric Rating Scale score were evaluated. RESULTS There was little correction loss for each radiological parameter of fracture reduction, and these parameters were not significantly different between the groups. The bone-healing rate of ulnar styloid fractures was significantly higher in the case group than in the control group, but the clinical results were not significantly different. CONCLUSIONS We revealed that there was no need to fix ulnar styloid fractures when distal radius fractures were treated via open reduction and internal fixation with a volar locking plate system.
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Affiliation(s)
- Hideyoshi Sawada
- Anjo Kosei Hospital, 28 Higashi Hirokute, Anjio-cho, Anjyo, 446-8602, Japan.
| | - Takaaki Shinohara
- Chunichi Hospital, 3-12-3 Marunouchi, Naka-ku, Nagoya, 460-0002, Japan
| | - Tadahiro Natsume
- Kariya Toyota General Hospital, 5-15 Sumiyoshi, Kariya, 448-8505, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Kim JK, Kim DJ, Yun Y. Natural history and factors associated with ulnar-sided wrist pain in distal radial fractures treated by plate fixation. J Hand Surg Eur Vol 2016; 41:727-31. [PMID: 26896455 DOI: 10.1177/1753193416630525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 01/04/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED We documented longitudinal changes in the incidence of ulnar-sided wrist pain after distal radial fractures treated by plate fixation and identified factors associated with ulnar-sided wrist pain. A total of 140 patients were enrolled in this study. Radiographs were taken 3 months after operation, and were used to measure radial inclination, anterior angulation and ulnar variance, and to identify the presence of an ulnar styloid fracture. Clinical assessments at the same time included grip strengths, ranges of wrist motion and the patient-rated wrist evaluation questionnaire. The presence of ulnar-sided wrist pain was noted at each follow-up visit. The incidence of ulnar-sided wrist pain decreased significantly with time after surgery (22 patients at 3 months, 11 patients at 6 months and three patients at 12 months). The mean age, sex, the presence of an ulnar styloid fracture and the classification of the distal radial fracture were not factors that were associated with a higher incidence of ulnar-sided wrist pain, but there was an association between higher patient-rated wrist evaluation scores and the presence of ulnar-sided wrist pain. LEVEL OF EVIDENCE Prognosis, Level IV.
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Affiliation(s)
- J K Kim
- Department of Orthopedic Surgery, Ewha Womans Universtiy Mokdong Hospital, Seoul, Korea
| | - D J Kim
- Department of Orthopedic Surgery, Ewha Womans Universtiy Mokdong Hospital, Seoul, Korea
| | - Y Yun
- Department of Orthopedic Surgery, Ewha Womans Universtiy Mokdong Hospital, Seoul, Korea
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