Surgical management of ulnar styloid fractures: comparison of fixation with anchor suture and tension band wire

Alvin Chao-Yu Chen,Chun-Ying Cheng,Yi-Hsuan Lin,Chun-Jui Weng

doi:10.1186/s13018-020-01795-3

Alvin Chao-Yu Chen, Chun-Ying Cheng + Show 2 more

Open Access

https://doi.org/10.1186/s13018-020-01795-3

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Abstract

BackgroundLimited 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.MethodsWe 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.ResultsBased 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).ConclusionSurgical 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.

Highlights

Limited reference is available regarding surgical management in symptomatic ulnar styloid fractures with small bony avulsion
Fractures of the ulnar styloid are commonly mentioned with the distal radius fracture (DRF) [3]; treatment options and prognosis are generally correlated with the presence of distal radioulnar joint (DRUJ) instability [4, 5]
Group A consisted of patients with small bony avulsion, comminuted fractures, and revision cases that underwent anchor suture fixation for the styloid fragment followed by percutaneous pinning of the distal radius and ulna with sparing the DRUJ

Summary

Introduction

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. For styloid base fracture with big avulsion fragment, tension band wiring or plate fixation is commonly adopted [6, 7]. There was limited reference regarding surgical management for small bony avulsion except for simple excision of the styloid fragment in cases with symptomatic nonunion [8]. The purpose of this study is to present a novel surgical technique using suture anchors to fix symptomatic ulnar styloid fractures with small bony fragments and to report treatment outcomes

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