Fracture Of Styloid Process Research Articles

Application of distal radius coronal bone structure matching in the treatment of distal radius fractures

To investigate the clinical effect of coronal bone structure matching(CBSM)in the treatment of distal radius fracture. A total of 39 cases of distal radius fracture between Jannary 2018 and Jannary 2022 were included in this study. Among them there were 22 males and 17 females with an average age of (48.9±16.3) years old, ranged from 22 to 65 years old. All patients were treated with open reduction and internal fixation with plates. Based on the measurement of CBSM value on the X-ray film the next day after surgery. All patients were divided into matched group and mismatched group according to the coronal bone structure matching in the normal range or not. There were 27 patients in the matched group, including 15 males and 12 females, the age ranged from 22 to 64 years old with an average of (48.0±16.2) years old. AO classification of fracture was C1 in 6 cases and C2 in 21 cases;the operation time ranged from 1 to 6 days after injury;9 cases were complicated with ulnar styloid process fracture. There were 12 patients in the mismatched group, including 7 males and 5 females;the age ranged from 22 to 65 years old with an average of (48.8±15.8) years old. AO classification of fracture was C1 in 4 cases and C2 in 8 cases;the time from injury to operation ranged from 1 to 5 days;4 cases were complicated with ulnar styloid process fracture. The X-ray films were used to evaluate fracture healing, humeral height, ulnar angle and palm tilt angle at 3 months after operation. The range of wrist motion(pronation, supination, palmar inclination and dorsiflexion), function outcomes(Gartland-Werley score) and pain levels (visual analogue scale, VAS) were compared between the two groups at the last follow-up. The average follow-up time of 39 patients were(9.5±4.3)months, ranged from 6 to 14 months. All patients healed in one stage without postoperative infection, fracture nonunion and fracture displacement occurred. Compared with match group at the last follow-up, the VAS in the mismatch group was increased[(2.5±1.3)points vs (1.6±1.0)points], the wrist pronation were decreased[(70.5±12.6)° vs (80.5±9.4)°], with statistically significant difference(P<0.05). There was no significant difference in the range of motion(supination, palmar inclination, dorsiflexion)and excellent good rate between the two groups at last follow-up after operation (P>0.05). Wrist dysfunction, limited pronation, and wrist pain may occur when the postoperative matching degree of the distal radius fracture is not within the normal range.

Operative versus non-operative treatment of ulnar styloid process base fractures: a systematic review and meta-analysis.

Ulnar styloid process (USP) fractures are present in 40-65% of all distal radius fractures (DRFs). USP base fractures can be associated with distal radioulnar joint (DRUJ) instability and ulnar sided wrist pain and are treated by conservative management and surgical fixation, without consensus. This systematic review and meta-analysis compares operative to non-operative treatment of concomitant ulnar styloid base fractures in patients with distal radius fractures. PubMed/Medline/Embase/CENTRAL databases were searched identifying RCTs and comparative observational studies. Effect estimates were extracted and pooled using random effect models to account for heterogeneity across studies. Results were presented as (standardized) mean differences (SMD or MD) or odds ratios (OR) and corresponding 95% confidence intervals (95%CI). Two RCTs (161 patients) and three observational studies (175 patients) were included. Tension band wiring was used for surgically treated USP fractures. Results were comparable across the different study designs and hence pooled across studies. Non-surgically treated patients had better wrist function at 6months (SMD 0.57, 95%CI 0.30; 0.90, I2 = 0%). After 12months there was no observed difference (MD 2.31, 95%CI -2.57; 7.19, I2 = 91%). Fewer patients had USP non-unions in the operative group (OR 0.08, 95%CI 0.04; 0.18, I2 = 0%). More patients suffered complications in the operative group (OR 14.3; 95%CI 1.08; 188, I2 = 89%). Routinely fixating USP base fractures as standard of care is not indicated. Surgery may be considered in selective cases (e.g. persistent DRUJ instability during ballottement test after fixation of the radius).

Comparative analysis of tension band wiring and hook plate fixation in ulnar styloid fractures: a focus on fracture type.

Various surgical techniques for ulnar styloid fractures (USFs) fixation have recently been developed, the actual clinical outcomes have not been discussed in detail. This study aimed to compare the outcomes of tension band wiring (TBW) and hook plate fixation in the treatment of USFs and to explore effective management strategies for these fractures. We retrospectively reviewed 109 patients with styloid process fractures from March 2016 to July 2020. Among them, patients aged 21-75 years who required surgical intervention for USFs with distal radioulnar joint (DRUJ) instability, with or without accompanying distal radius fracturs (DRFs), were included. The patients were treated with either TBW (group T) or hook plate fixation (group P). The fractures were classified into four types based on their location and complexity. Postoperative assessments were conducted using radiographic analysis to monitor fracture healing. Clinical evaluations, including range of motion (ROM), grip strength, and patient-reported outcomes using the disabilities of the arm, shoulder, and hand scores and the visual analog scale for pain, were performed, at multiple time points up to a year after surgery. Statistical analyses were conducted to compare outcomes across fracture types and treatment methods. Osseous union was achieved in 96% of the patients. Specifically, the time to union in types 3 and 4 fractures was significantly shorter in group P than in group T. Functionally, ROM assessments showed similar flexion-extension in both groups but better pronation-supination in group T. Grip strength and patient-reported outcomes did not show significant differences between the groups. TBW offers slight ROM benefits for type 2 USFs, whereas hook plate fixation provides superior stability for complex types 3 and 4 USFs. Despite the minimal differences in ROM, the enhanced advantages of the hook plate fixation make it the preferred choice for severe fractures, ensuring faster healing.

Pathophysiological mechanisms, diagnosis and treatment of the fractures of the temporal bone styloid process

The styloid process is a needle-like osseous projection beneath the temporal bone, typically measuring 2.5-3 cm. Its fracture is uncommon and mostly occurs in elongated processes, often due to trauma, dental procedures, or sports. This paper presents an unusual case of a normallength styloid process fracture in a 24-year-old serviceman, resulting from a mine explosion. The patient complained of intense headaches, and pain during yawning, swallowing, and head rotation. Examination revealed pain in the left pterygopalatine fossa, and decreased pharyngeal reflex on the left, and a CT scan showed brain contusion, subarachnoid haemorrhage and a linear fracture in the normal-sized left styloid process, with no displacement. Treatment with anti-inflammatory drugs and muscle relaxants led to symptoms improvement, and no fragment dislocation was observed in a follow-up CT. This report contributes to understanding the diagnosis of normal-length styloid process fractures, contrasting with the more reported elongated ones.

Influence of Ulnar Styloid Fracture Types on the Treatment of Distal Radius Fractures

Objective: To analyze the effect of ulnar styloid process fracture types on the treatment of distal radius fracture. Methods: A total of 49 patients with distal radius fractures admitted to the hospital between December 1, 2018 and November 30, 2022 were selected. Among the patients, 26 of them were complicated with type I ulnar styloid fracture (the first group), and 23 patients were complicated with type II ulnar styloid fracture (the second group), and were treated with open reduction and internal fixation using Kirschner wire and tension band. The total effective rate, anatomical indicators such as palm inclination and ulnar deviation, and the range of motion of the wrist joint were compared between the two groups. Results: The total effective rate of the first group was higher than that of the second group (P &lt; 0.05). There was no difference in anatomical indicators between the groups before operation and 3 months after operation (P &gt; 0.05). Before operation, there was no difference in the range of motion of the wrist joint between the groups (P &gt; 0.05). 3 months after operation, the range of motion of the wrist joint in the first group was greater than that in the second group (P &lt; 0.05). Conclusion: The types of ulna styloid fracture can affect the effectiveness of treatment and joint mobility of distal radius fracture.

P05 Osteoporosis in thalassemia; a case with multifactorial aetiology

Abstract Introduction Thalassemia patients are prone to osteoporosis due to multifactorial reasons, including anaemia, bone marrow expansion, iron overload and hypogonadism. Case description A 41-year-old British Asian male with beta thalassemia major was referred to rheumatology in 2018 for osteoporosis. In 2008, aged 27 years, whilst playing football, he developed a distal radial fracture and ulnar styloid process fracture and a DEXA scan had revealed low bone mineral density (BMD) for age. Subsequently, he was started on Ibandronic acid by his haematologist for a total of 10 years. After he was referred to rheumatology in 2018, bisphosphonates were discontinued as he had 5% improvement in BMD, a decade of bisphosphonates and no further fractures. Further assessment revealed multiple contributory factors for his osteoporosis. • Consistency low vitamin D – 9.6 nmol/L in 2009, average value of 20 • He was diagnosed with hypogonadism, poor compliance with IM testosterone injections • He had diabetes which was not optimally controlled • Evidence of iron overload with average serum ferritin of 2000 ug/L with deferasirox While these factors were optimised, it was decided to adopt a watch and wait policy with regards to specific osteoporosis treatment. Review in 2023 revealed serum testosterone level of 20.1 nmol/L (6.9-23.2) with better compliance with testosterone injections. Fructosamine levels were 310 (normal range 200-285) but it has reduced from a peak of 370. Serum ferritin levels have reduced to 776 down from a high of 5600. Normal vitamin D levels were maintained. The DEXA scan in 2023 revealed a spine T score of −2.4 which showed 10.2% increase in bone mineral density. DEXA scan in 2020 revealed T score of −3.1 in spine and −1.9 in hips. The P1NP level was 56 (19-69) which has reduced from 100 in 2021. Improvements in BMD and bone turnover markers were achieved through optimising contributory factors without any specific osteoporosis treatment. He will be monitored with periodic BMD and bone turnover markers. Discussion Anaemia and subsequent bone marrow expansion is a recognised cause for osteoporosis in thalassemia patients. While regular blood transfusions inhibit bone marrow expansion, ineffective erythropoiesis is not fully supressed. This patient received 3 units of blood every 4 weeks. Bone marrow expansion occurs mostly in trabecular bone resulting in low BMD is areas which generally have increased amount of trabecular bone such as the spine. Our patient had a lower BMD in the spine compared to the femoral neck. Iron overload directly disrupts bone formation and can result in endocrinopathies which contributes to osteoporosis. Hypogonadism is another well-recognised cause and is primarily results from iron deposition in pituitary and at times in the gonads. Hormonal replacement therapy reduces bone loss. Studies have shown that hypogonadic patients have more severe osteoporosis and predominant involvement of the femoral neck. Iron overload can cause diabetes mellitus and impaired growth hormone/ insulin growth factor-1 (IGF-1) axis which can contribute to osteoporosis. Our patient did have diabetes but had normal IGF-1 levels when checked previously. Deferoxamine which is one of iron chelating agents have been shown to reduce collagen synthesis and increases osteoblast apoptosis which might contribute to the development of osteoporosis. Vitamin D levels are well known to be low in patients with thalassemia compared to the general population. While there are no RCT’s to show that bisphosphonates reduce fracture risk, surrogate markers such as increased BMD and reduction in bone turnover markers are known to occur. Therefore, current guidance (Standards for the Clinical Care of Children and Adults with Thalassaemia in the UK) recommends bisphosphonates to be considered in patients with a low BMD for age (Z-score &amp;lt; −2.0, T-score &amp;lt; −2.5 if post-menopausal or over 50), if there are fragility fractures or falling BMD despite adequate vitamin D levels, and hormone supplementation. Key learning points Learning point Important to assess for osteoporosis in thalassaemic patients. There are multiple factors contributing to the development of osteoporosis which needs to be addressed together with endocrinologist and haematologist. Bisphosphonates are recommended though further RCT evidence is required to support this

Fixed Subluxation of the Distal Radioulnar Joint following Malunion of the Ulnar Styloid Process.

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.

Fracture of the Elongated Styloid Process by Hanging

It is a routine protocol to examine the soft tissues, cartilage and bone tissues of the neck during post-mortem examinations performed in the cases of hanging-related deaths. Fractures of the hyoid bone and thyroid cartilage, as well as bleeding and ecchymoses around the first fracture are practically of great importance in establishing the case as live hanging. The styloid process is a thin bone at the base of the skull that extends downward, medially, and anteriorly from the temporal bone. Elongated variations of styloid process are encountered in society. In literature, there are no reported cases of elongated styloid process fractures due to hanging. In hanging-related deaths, along with hyoid bone and thyroid cartilage tissues, styloid process should also be evaluated for fractures.

Clinical Outcomes of Arthroscopic One-Tunnel Triangular Fibrocartilage Complex Transosseous Suture Repair Are Not Diminished in Cases of Ulnar Styloid Process Fracture Nonunion

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). 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. 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. 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 III, retrospective comparative study.

OUTCOMES OF CLOSED UNSTABLE DISTAL RADIUS FRACTURES OPERATED AND FIXED WITH VARIABLE ANGLE LOCKING PLATE

INTRODUCTION AND AIM: This study aims to evaluate the functional and radiological outcomes in unstable distal end radius fractures treated with variable angle locking plates. MATERIAL AND METHODS: We reviewed 20 unstable distal end radius fractures that were operated and xed with variable-angle locking plate. RESULTS: According to Green and O'Brien Score (Cooney's modication) , excellent results were reported in 70 %,while good results were present in 20% cases, fair results were seen in 10% cases. CONCLUSION: The use of variable angle locking plates (VALP) in treating unstable distal end radius fractures is associated with excellent to good functional outcomes with minimal complications. VALP allows subchondral purchase in the articular fragments due to the exibility in the implant as far as plate positioning (that can be placed even beyond watershed line for very distal radius fractures) and as far as screw positioning in different directions (that can hold various distal fracture fragments as well as styloid process fracture). By this way, VALP helps in maintaining the reduction and predictably yields better functional outcome especially in unstable distal end radius fractures with early return to pre-injury occupation.

The popliteofibular ligament: a cadaveric ultrasound study

ObjectiveThe popliteofibular ligament (PFL) is an important stabilizer of the knee found within the posterolateral corner (PLC) of the joint. Injuries to the PLC can cause substantial patient morbidity. Accurate PFL visualization has been historically challenging, impeding injury diagnosis and treatment. The gold standard for in vivo PFL visualization is magnetic resonance imaging (MRI), but this procedure has slice thickness limitations, is costly, and is subject to longer wait times. Ultrasonographic (US) PFL assessment is a potentially viable alternative to MRI. This study aimed to determine the viability of US PFL assessment.Materials and methodsTen fresh-frozen lower limb specimens were evaluated for the presence and morphometric characteristics of the PFL via US using an 18.0-MHz linear transducer. The cadavers were then dissected and reassessed for the presence and morphometric characteristics of the PFLs for comparison with US findings. Moreover, the fracture of the fibular styloid process near the site of the insertion of the PFL (the arcuate sign) was simulated and assessed via US.ResultsThe PFL was visualized and measured in all ten knees via both US and cadaveric assessments. There were no statistically significant differences in PFL morphometric characteristics determined via US examination and dissection. The fibular styloid fracture was easily identified in US examination.ConclusionUS imaging is a viable alternative for accurate and effective assessment of the normal PFL. Moreover, the arcuate sign can be evaluated via US.

Surgical treatment of the ulnar styloid process using an angle-stable hook plate in fractures and symptomatic nonunions

Anatomical reduction of dislocated fractures using an angle-stable hook plate. Surgical revision of symptomatic nonunions with the aim of bone regeneration. 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. Undisplaced fractures of the ulnar styloid process and asymptomatic nonunions. 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. Depending on the accompanying injury, immobilization in aforearm plaster splint for 1-2weeks. Active movement exercises of the fingers from postoperative day1, if necessary lymph drainage. After bone development, load build-up under ergotherapy guidance. 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 anangle-stable hook plate has proven to be successful.

橈骨遠位端骨折に伴う尺骨遠位端骨折（茎状突起骨折単独を除く）の特徴と治療成績

橈骨遠位端骨折に伴う尺骨遠位端骨折（茎状突起骨折単独を除く）の特徴と治療成績

The CAST study protocol: a cluster randomized trial assessing the effect of circumferential casting versus plaster splinting on fracture redisplacement in reduced distal radius fractures in adults

BackgroundThere is no consensus concerning the optimal casting technique for displaced distal radius fractures (DRFs) following closed reduction. This study evaluates whether a splint or a circumferential cast is most optimal to prevent fracture redisplacement in adult patients with a reduced DRF. Additionally, the cost-effectiveness of both cast types will be calculated.Methods/designThis multicenter cluster randomized controlled trial will compare initial immobilization with a circumferential below-elbow cast versus a below-elbow plaster splint in reduced DRFs. Randomization will take place on hospital-level (cluster, n = 10) with a cross-over point halfway the inclusion of the needed number of patients per hospital. Inclusion criteria comprise adult patients (≥ 18 years) with a primary displaced DRF which is treated conservatively after closed reduction. Multiple trauma patients (Injury Severity Score ≥ 16), concomitant ulnar fractures (except styloid process fractures) and patients with concomitant injury on the ipsilateral arm or inability to complete study forms will be excluded. Primary study outcome is fracture redisplacement of the initial reduced DRF. Secondary outcomes are patient-reported outcomes assessed with the Disability Arm Shoulder Hand score (DASH) and Patient-Rated Wrist Evaluation score (PRWE), comfort of the cast, quality of life assessed with the EQ-5D-5L questionnaire, analgesics use, cost-effectiveness and (serious) adverse events occurence. In total, 560 patients will be included and followed for 1 year. The estimated time required for inclusion will be 18 months.DiscussionThe CAST study will provide evidence whether the type of cast immobilization is of influence on fracture redisplacement in distal radius fractures. Extensive follow-up during one year concerning radiographic, functional and patient reported outcomes will give a broad view on DRF recovery.Trial registrationRegistered in the Dutch Trial Registry on January 14th 2020. Registration number: NL8311.

Characteristics of lower limb injuries in non-fatal road traffic accidents: a retrospective analysis of forensic medical examinations

Background. Fractures of the lower limbs are one of the most common injuries in road traffic accidents, however, the frequency and localization of fractures, as well as associated trauma, are not well understood. The purpose of the study was to conduct a retrospective analysis of forensic medical examinations of victims with the road traffic injuries of the lower limbs. Results. The research material was 100 reports of forensic medical examinations of victims with fractures of the femur and/or shin bones resulting from a non-fatal road traffic accidents. The study found that the average age of the victims was 41.5 ± 18.8 years (18 - 81 years). The main contingent of those injured was pedestrians (82%). In victims, the most common injury was polytrauma; closed limb fractures were more common. Hip fractures of various localization were found in 39%, shin fractures - in 59%, ankle fractures - in 12%. Closed head injury with a concussion of the brain of a mild degree (23%), closed fractures of the ribs (3%), self-healing dislocation of the humerus (1%), diaphyseal fractures of the forearm (3%), distal radial bone fractures (7%), and fractures of styloid process of the ulna (2%) were also noted. Conclusions. The main victims of road traffic accidents are pedestrians with polytrauma. The most common localization of fractures of the lower extremities is the diaphysis of the femur and the diaphysis of the shin bones.

Factors predictive for union of basal fracture of the ulnar styloid process after distal radial fracture fixation using a volar locking plate

BackgroundSome 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. MethodsWe 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. ResultsGroup 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). ConclusionsApproximately 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 evidenceLevel III, Case–control study.

Effectiveness of volar oblique T-type locking plate and raft screws reduction and fixation in treatment of extreme distal radius fractures

To investigate the effectiveness of volar oblique T-type locking plate and raft screws reduction and fixation in the treatment of extreme distal radius fractures. Between July 2014 and July 2018, 15 patients with extreme distal radius fractures were treated with volar oblique T-type locking plate and raft screws reduction and fixation. There were 6 males and 9 females, aged from 30 to 66 years with an average age of 56.6 years. The cause of injury was falling from height in 2 cases and falling in 13 cases. All of them were fresh closed injuries. The fractures were rated as type 23C1 in 8 cases and as type 23C2 in 7 cases according to AO/Orthopaedic Trauma Association (AO/OTA) classification. There were 7 cases of ulnar styloid process fracture and 2 cases of distal radioulnar joint instability. The time from injury to operation was 6 to 9 days with an average of 7.3 days. The fracture healing and the radial height, palm inclination, and ulnar deviation were observed by X-ray reexamination. Cooney score was used to evaluate the effectiveness. All incisions healed by first intention. All patients were followed up 12-24 months, with an average of 14.6 months. X-ray films showed that all fractures healed, and the healing time ranged from 5 to 10 months, with an average of 8.2 months. No internal fixation failure or secondary fracture displacement occurred. At last follow-up, the radial height, palm inclination, and ulnar deviation recovered well, and the differences between pre- and post-operation were significant ( P<0.05). The pain, function, activity, and grip strength scores and the total score of Cooney score were significantly higher than those before operation ( P<0.05). There were 11 cases of excellent, 3 cases of good, and 1 case of good, with an excellent and good rate of 93%. For extreme distal radius fractures, the volar oblique T-type locking plate and raft screws reduction and fixation can restore the radialheight, palm inclination, and ulnar deviation, fix firmly, and recover the wrist joint function exercise early, and obtain satisfactory effectiveness.

Cervico-stylo-mandibular complex fracture: a critical review of literature along with a protocol to recognize and proposal of a new classification.

Fractures of the styloid process of the temporal bone may occur with or without an obvious relation to trauma. The incidence of either isolated styloid process fracture or in combination with mandibular fractures is rare, and such occurrences are often misdiagnosed or neglected. A fractured styloid when displaced may impinge on adjacent vital structures, leading to neurological or vascular symptoms that vary according to the anatomical structure compressed. Styloid process fractures associated with atlas/C1 fractures have also been rarely reported in the literature. In this review of literature, the majority of patients was treated conservatively, as few demonstrated the necessity of surgical intervention. There is a definitive need for a protocol to recognize and classify styloid fractures to plan for further treatment. The aim of this review was to achieve a comprehensive understanding of all types of styloid fractures, determine the clinical severity of symptoms, and to consider management and prognosis. In addition, a new classification of cervico-stylo-mandibular fractures is proposed based on important evidence in the literature regarding clinical and radiographic factors that might influence the treatment and prognosis of such fractures.

The influence of radial displacement in distal radius fracture on the stability of distal radioulnar joint

Objective To investigate the causes of instability of distal radioulnar joint caused by displacement in distal radius fracture, and to analyze the importance of radial displacement in distal radius fracture to wrist stability. Methods There were 60 patients with distal radius fracture, 22 males and 38 females, aged from 26 to 67 years, with an average age of 41 years. There were 29 cases with ulnar styloid process fracture and 31 cases without ulnar styloid process fracture. According to the degree of displacement, they were divided into three groups: 13 cases with displacement less than 2 mm, 20 cases with displacement more than 2 mm and less than 4 mm, and 27 cases with displacement more than 4 mm. All the patients were treated with open reduction and plate internal fixation of distal radius fracture. The stability of distal radioulnar joint was examined after plate fixation. Fifteen patients with unstable distal radioulnar joint examined by intraoperative physical examination (associated with ulnar styloid process fracture) were divided into two groups. In one group, the styloid process of ulna was fixed with steel wire, while in the other group the styloid process of ulna was not fixed. The effect of radial displacement on ulnar styloid process after distal radius fracture and the effect of ulnar styloid process fracture on the stability of distal radioulnar joint were analyzed. The degree of radial displacement of distal radius fracture and the effect of ulnar styloid process fracture on the stability of distal radioulnar joint were evaluated according to the postoperative follow-up of palmar inclination angle, ulnar deviation angle and wrist function score. Results The injury of TFCC when radial displacement of distal radius fracture was greater than 4 mm was the main cause of instability of distal radioulnar joint and affecting wrist function. There was statistically significant difference in the incidence of distal radioulnar joint instability whether distal radial fractures accompanied by ulnar styloid process fractures or not. There was significant difference between radial displacement greater than 4 mm and ulnar styloid process fracture. Conclusion The radial displacement of distal radius fracture has great influence on the stability of distal radioulnar joint. There are more patients with ulnar styloid process fracture in the instability of distal radioulnar joint. The ulnar styloid process fracture suggests a higher risk of TFCC injury. The good reduction of ulnar styloid process plays an important role in the stability of distal radioulnar joint. Key words: Radius; Fractures,bone; Distal radioulnar joint; Triangular fibrocartilage complex; Ulnar styloid process

Analysis of influencing factors of wrist dorsal extension angle and function after radius distal fracture surgery

Objective To explore the influencing factors of wrist dorsal extension angle and wrist function recovery after distal radius fractures. Methods From July 2012 to January 2016, 116 patients with distal radius fractures were treated with palmar plate internal fixation. Follow-up included wrist range of motion, X-ray, measurement of imaging parameters, complications, grip strength, pinch strength, PRWE and DASH scores. According to the recovery of dorsal extension angle and Gartland-Werley scoring criteria, patients with dorsal extension angle less than 45° were classified as groupⅠ (functional restricted group), and patients with dorsal extension angle more than 45° were classified as group Ⅱ (functional unrestricted group). Then, the differences of age, injury side, fracture type, imaging parameters, ulnar styloid process fracture and complications between the two groups were compared, and whether these factors were the influencing factors of different dorsal extension angles were judged. The effects of these factors on wrist PRWE and DASH scores were analyzed. Results There were no significant differences in age, injured side, fracture type, imaging parameters and whether there were fractures of ulnar styloid process between the two groups (P>0.05). There were significant differences in wrist flexion angle, ulnar deviation angle, pronation angle and grip strength between the two groups. The parameters of groupⅠwere lower than those of groupⅡ(P<0.05). The survival analysis of influencing factors of wrist dorsal extension recovery showed that the recovery of ulnar inclination and palmar inclination had an effect on wrist dorsal extension by univariate analysis, while age had an effect on wrist dorsal extension by multivariate analysis; age and ulnar variation had an effect on PRWE score by univariate analysis, and gender and ulnar variation had an effect on PRWE score by multivariate analysis; age had an impact on DASH score by univariate analysis, and gender had an impact on DASH score by multivariate analysis. Conclusion Patients' age, ulnar inclination and palmar inclination are important factors affecting wrist dorsal extension, while age, gender and ulnar variation affect PRWE and DASH scores in varying degrees. Key words: Radius fractures; Wrist joint; Dorsal extension; Influencing factors