Ulnar Styloid Fractures Research Articles

Relationship between Fracture of the Ulnar Styloid Process and DRUJ Instability: A Biomechanical Study.

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.

Patient-reported outcomes after corrective osteotomy for a symptomatic malunion of the distal radius.

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. 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. 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). 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.

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.

Analysis of the Variables Affecting the Outcome of Management of Distal Radius Fractures with a Variable-Angle Volar Locking Plate

Background: The new low-profile plates and locking systems have popularized surgical options. Treatment modalities exist for surgical management of distal radius fractures, including open reduction and internal fixation (ORIF) with volar or dorsal plates and screws. Objectives: This study aimed to find a possible correlation between various parameters, either patient-related (age, bone quality) or fracture-related (type, reduction), and to analyze the impact of these factors on the radiological and clinical outcome of distal radius fractures treated by a variable-angle volar locking plate. Patients and Methods: The study included 18 patients suffering from fractures of the distal radius admitted to the Orthopedic Department in Zagazig University Hospital. All patients were operated from January 2019 to June 2019. A total of 18 patients complete at least 6 months follow up period. Results: The results were assessed according to the disabilities of arm, shoulder, and hand scoring system (DASH score), eight patients had excellent results with average 3.54 ±1.23, eight patients had good results with average 9.71 ±1.97. Conclusions: There was a negative correlation between patients’ age, sex, type of fracture, or presence of an associated ulnar styloid fracture and the final score. This correlation was statistically insignificant. A correlation was found between the affected dominant hand or number of rows of distal screws and the final functional score. this was found to be statistically significant.

Analysis of the Variables Affecting the Outcome of Management of Distal Radius Fractures with a Variable-Angle Volar Locking Plate

Background: The new low-profile plates and locking systems have popularized surgical options. Treatment modalities exist for surgical management of distal radius fractures, including open reduction and internal fixation (ORIF) with volar or dorsal plates and screws. Objectives: This study aimed to find a possible correlation between various parameters, either patient-related (age, bone quality) or fracture-related (type, reduction), and to analyze the impact of these factors on the radiological and clinical outcome of distal radius fractures treated by a variable-angle volar locking plate. Patients and Methods: The study included 18 patients suffering from fractures of the distal radius admitted to the Orthopedic Department in Zagazig University Hospital. All patients were operated from January 2019 to June 2019. A total of 18 patients complete at least 6 months follow up period. Results: The results were assessed according to the disabilities of arm, shoulder, and hand scoring system (DASH score), eight patients had excellent results with average 3.54 ±1.23, eight patients had good results with average 9.71 ±1.97. Conclusions: There was a negative correlation between patients’ age, sex, type of fracture, or presence of an associated ulnar styloid fracture and the final score. This correlation was statistically insignificant. A correlation was found between the affected dominant hand or number of rows of distal screws and the final functional score. this was found to be statistically significant.

Ulnar footprints of the distal radioulnar ligaments: a detailed topographical study in 21 cadaveric wrists.

Understanding of the exact topography of the distal radioulnar ligaments insertions remains limited. An anatomical study was performed in 21 fresh frozen cadaveric wrists, where the superficial and deep ligaments were sequentially transected sharply at their ulnar insertions. The relationships between the distal radioulnar ligament footprints relative to the bony landmarks of the ulnar styloid were digitized. Our study demonstrated that in the coronal plane, the superficial distal radioulnar ligaments inserted at an average of 87% of the styloid height proximally to the styloid tip distally. The deep distal radioulnar ligaments inserted at an average of 81% of the styloid height distally to the fovea proximally. The superficial footprint had an area of 10.6 mm2 on the ulnar styloid. The deep distal radioulnar ligaments attachment was asymmetric and generally had two separate footprints. This study adds important topographical knowledge about the footprint of the distal radioulnar ligaments and may contribute to understanding the consequences of ulnar styloid fractures and distal radioulnar ligaments lesions.

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

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.

MRI Findings in Patients Undergoing Triangular Fibrocartilage Complex Repairs Versus Patients Without Ulnar-Sided Wrist Pain.

Background: The clinical picture of ulnar-sided wrist pain is oftentimes confusing because various pathologies may be coexistent. In this study, we aimed: (1) to compare the prevalence of potential causes of ulnar-sided wrist pain on magnetic resonance imaging (MRI) in patients who underwent triangular fibrocartilage complex (TFCC) repair and control subjects: and (2) to evaluate whether inferior clinical results were associated with specific patient characteristics or other potential causes of ulnar-sided wrist pain. Methods: We included 67 patients who underwent a TFCC repair and 67 control subjects. The MRI scans were examined for sources of ulnar-sided wrist pain. After TFCC repair, 42 patients (63%) completed surveys, including Quick Disabilities of the Arm, Shoulder and Hand and pain scores. Bivariate analysis was performed to compare our groups and to identify factors associated with our outcomes. Results: We found significantly higher rates of distal radioulnar joint (DRUJ) arthritis (P = .033), extensor carpi ulnaris (ECU) pathology (P = .028), and ulnar styloid fractures (P = .028) in patients with TFCC repairs. With increasing age, increasing pathology in the pisotriquetral joint (P = .040), more ulnocarpal abutment (P = .0081), and more degenerative tears (P < .001) were seen in both groups. No demographic characteristics or MRI findings were significantly associated with our outcomes. Conclusions: We observed higher rates of DRUJ arthritis and ECU pathology in patients with TFCC tears undergoing repair compared with age- and sex-matched controls. This may be due to damage to the TFCC itself altering relationships of the DRUJ and the ECU subsheath, or it may reflect various pathologies that cause ulnar-sided wrist pain and drive patients toward surgery.

Treatment Modality of Distal Ulnar Head and Neck Fractures Associated With Operatively Treated Distal Radius Fractures Does Not Affect Outcomes.

Background: This study compares the functional outcomes and complications between operatively and nonoperatively treated distal ulnar head and neck fractures associated with internal fixation of concomitant distal radius fractures. Methods: A 7-year retrospective chart review was performed to identify patients with operatively treated distal radius fractures associated with distal ulnar head and neck fractures. Ulnar styloid fractures were excluded. Fifty-eight patients who had a minimum of 6 months of follow-up were identified. Patients were divided into 3 treatment groups: nonoperative, open reduction internal fixation (ORIF), and distal ulna resection. Reviewed data included demographics, injury and treatment details, complications, and patient-reported outcome measures. Outcomes measures included Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity and Patient-Rated Wrist Evaluation (PRWE) surveys. Due to inadequate power, 5 patients treated with distal ulna resection were excluded from statistical analysis. Results: The average patient age was 56 years, with an average follow-up of 27 months. All patients underwent ORIF of the distal radius fracture. Distal ulna fractures were treated nonoperatively in 25 patients, with ORIF in 28 patients, and with distal ulna resection in 5 patients. There were no statistically significant differences in wrist or forearm range of motion, complication rates, secondary procedure rates, PRWE scores, or PROMIS scores between ORIF and nonoperative treatment. Conclusion: No differences in wrist or forearm range of motion, complication rates, secondary procedure rates, PRWE scores, or PROMIS scores were observed between ORIF and nonoperative treatment of distal ulnar head and neck fractures associated with operatively treated distal radius fractures.

Effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function of patients with distal radius fracture

To study the effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function in patients with distal radius fracture. In total, 139 patients treated for distal radius fracture in the Department of Orthopedic Trauma at Peking University People's Hospital from Jan. 2006 to June 2016 were selected for outpatient follow-ups. Evaluation was based on Sartiento's modification of the Gartland and Werley scores. Efficacy was assessed with wrist pain as the focus. The excellent and good efficacy rate was 97.1% (excellent: n=107, 77.0%; good: n=28, 19.4%; and fair: n=4, 2.9%). Gender, age, and whether the ulnar styloid fracture achieved union did not significantly impact the scores (P>0.05). The scores of the basal fracture group were significantly different (P=0.001). Internal fixation of ulnar styloid fracture was associated with a significant difference in scores (P=0.005). The effect of sigmoid notch fracture was also associated with a significant difference in scores (P=0.024). This study included 22 cases of ulnar wrist pain, and the overall incidence of ulnar wrist pain was 15.8%. Gender, age, whether the ulnar styloid fracture achieved union, and whether internal fixation was conducted for ulnar styloid fracture and sigmoid notch fracture had no significant effect on the occurrence of ulnar wrist pain (P>0.05). The incidence of ulnar wrist pain was higher in basal fractures than that in tip fractures. Among ulnar styloid fractures, the union rate of basal fracture was higher than that of tip fractures. The union rates of basal fracture and tip fracture were significantly different (P<0.001). Basal fractures were significant risk factors for ulnar wrist pain (P=0.028). Basal fracture of the ulnar styloid group and sigmoid notch fracture group had poor wrist function scores. Wrist function score improved significantly after internal fixation of ulnar styloid fracture. The incidence of ulnar wrist pain was higher in basal fracture group. The union rate in basal fracture group was higher than in tip fracture group. The overall effect of surgical treatment of distal radius fracture is satisfactory. Ulnar styloid basal fracture and sigmoid notch fracture are risk factors for postoperative wrist dysfunction in patients with distal radius fracture, and the basal fracture is one of the risk factors of ulnar wrist pain. The union rate of ulnar styloid basal fractures is better than that of tip fractures. Internal fixation of ulnar styloid fracture can improve wrist function.

The Presence and the Location of an Ulnar Styloid Fracture Associated With Distal Radius Fracture Predict the Presence of Triangular Fibrocartilage Complex 1B Injury

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. 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. 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). 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 IV, Case series.

Association between bone mineral density and ulnar styloid fracture in older Japanese adults with low-energy distal radius fracture.

The pathogenesis of ulnar styloid fracture (USF), which often occurs with distal radius fracture (DRF), is unclear. This study aimed to investigate whether USF concomitant with low-energy DRF was associated with the bone mineral status and the degree of radiographically observed pretreatment radius displacement in Japanese adults above 50years of age. The study subjects were 45 (44 female, 1 male) consecutive patients aged > 50years with DRF caused by falls from June 2015 to May 2016. Fractures due to high-energy injuries were excluded. Patients were divided into two groups according to the presence or absence of USF. Radius displacement was assessed on anteroposterior and lateral radiographs by measuring ulnar variance, radial inclination, and volar tilt at initial examination before manual reduction of the bone. Bone mineral density (BMD) of the lumbar spine, femoral neck, and distal radius was also measured by dual-energy X-ray absorptiometry within 1week of injury. Significant differences in the BMD values of femoral neck, ulnar variance, radial inclination, and volar tilt were found between patients with USF and those without USF (all comparisons, p < 0.05). Logistic regression analysis of all subject data identified that volar tilt was significantly associated with the presence of USF (p = 0.048). The presence of USF in low-energy DRF correlates with the decreased BMD of femoral neck and severe displacement of radius in elderly patients. These findings are helpful for the treatment of osteoporosis to prevent subsequent fragility fracture.

Impact of Ulnar Styloid Fractures on the Treatment Effect of Distal Radius Fractures with Volar Plate Fixation: A Case Control Study.

There is a controversy regarding whether ulnar styloid fractures affect the efficacy of treatment of distal radial fractures. The purpose of this study was to investigate whether ulnar styloid fractures impact wrist joint function in patients without distal radioulnar joint instability, after distal radial fracture fixation using a volar plate. Seventy-five patients with a distal radial fracture were treated using a volar plate between February 2010 and February 2016 (33 men and 42 women; mean age 40.9 ± 9.4years). Forty-four patients had ulnar styloid fractures (Group A) and 31 patients did not (Group B). There were no differences between the two groups with regard to sex, age, course of the disease and fracture type (P > 0.05). The mean follow-up time was 21months. There were no differences between the groups in palmar tilt, radial inclination and radial length when the distal radial fractures had healed (P > 0.05). At the final follow-up visit, the two groups were similar in terms of wrist motion range, and grip and pinch strength (P > 0.05). The Gartland-Werley scores were 13 for excellent, 26 for good, 3 for fair and 2 for poor (excellence rate 89%) for Group A, and 10 for excellent, 17 for good, 2 for fair and 2 for poor (excellence rate 87%) for Group B. The difference between the two groups was not significant (Z = - 0.097, P = 0.922). After open reduction and plate fixation of distal radial fractures, if stability of the distal radioulnar joint is achieved, untreated ulnar styloid fractures have no impact on wrist joint function.

EFFECT OF ULNAR STYLOID FIXATION ON FUNCTIONAL AND RADIOLOGIC OUTCOMES AFTER DISTAL RADIUS FRACTURES

ABSTRACT Background: The aim of this study was to compare the functional and radiological outcomes of ulnar styloid fractures, with or without internal fixation, that followed distal radius fractures. Methods: Between January 2011 and June 2017, 206 distal radius fractures were operated on in our hospital. In total, 71 patients were included in the study. Thirty-five ulnar styloid fractures were fixed, and Thirty-six could not be fixed. The mean age of patients was 45 years (20–64 years), and the mean follow-up time of patients was 19 months (12–30 months) Results: In the unfixed ulnar styloid fracture group, the QuickDASH score was 20.8 and Mayo wrist score was 65. On the other hand, in the fixed ulnar styloid fracture group, the Quick DASH score was 11 and Mayo wrist score was 75. When comparing the groups, no statistically significant differences were found between their Quick DASH scores, Mayo wrist scores, grip strength, and wrist movements (p>0.05). In the unfixed group, 10 nonunions were observed, while in the fixed group, 9 nonunions were observed. Conclusion: In our study, ulnar styloid fracture fixation did not affect the functional outcomes of distal radius fractures. Surgeons should be more selective for ulnar styloid fixation in patients with ulna styloid fracture combined wrist fractures.

Scapholunate, lunotriquetral and TFCC ligament injuries associated with intraarticular distal radius fractures: Arthroscopic assessment and correlation with fracture types

The aim of this study was to evaluate the prevalence of arthroscopic scapholunate (SL) and/or lunotriquetral (LQ) laxity and triangular fibrocartilaginous complex (TFCC) injuries in patients who have an intraarticular fracture of the distal radius and to correlate these lesions with fracture type. Fifty-seven intraarticular radius fractures, whether or not they were associated with an ulnar styloid fracture, were evaluated and treated by arthroscopy. Scapholunate and lunotriquetral ligament injuries were classified according to the EWAS classification. TFCC lesions were assessed according to Palmer's classification. Each injury was documented through preoperative X-rays and a CT scan. Fracture type and soft tissue injury were not significantly associated one to another. Arthroscopic examination revealed at least one soft tissue injury in 39 intraarticular fractures of the distal radius (68.4%). Twenty-five percent of arthroscopic SL laxities (including severe EWAS 3 injuries) were not detected on standard radiographs. Arthroscopic SL laxity was present in 8 of 11 cases (72.7%) of radial styloid fracture and in 15 of 25 cases (60%) of fractures with at least one radial styloid component. There was no association between LQ integrity and fracture type. Ulnar styloid fractures (base or tip) and TFCC lesions were significantly correlated (P<0.0001). The prevalence of soft tissue lesions secondary to intraarticular fractures of the distal radius was 68.4%. However, there was no statistically significant relationship between the different types of radius fractures and soft tissue injuries. On the other hand, ulnar styloid fracture was predictive of TFCC injury.

Inducing life-like distal radius fractures in human cadaveric specimens: a tool for enhanced surgical training.

Surgical education consists often times of a discrepancy between necessary amount of provided operative teaching and amount of organizational and ward duties. Operative education is often cut to a minimum. As public awareness toward surgical competence raises, so must the educational system. Courses that provide pre-fractured cadaveric specimens can facilitate surgical teaching realistically, prior to operating on living patients. The aim of this study is to introduce a realistic distal radius fracture simulation setup. 12 cadaveric specimens (3 male, 9 female) were fixed onto a custom drop-test-bench in the hyperextension of the wrist. The forearm was cut midway between elbow and carpus. The distal part of the forearm was potted, and the specimen was exposed to a high energetic impulse. CT imaging was performed after fracture simulation to detect the exact fracture patterns. We used the AO/ASIF recommendations and four-corner concept to classify the achieved fractures by two independent trauma surgeons. All cadaveric specimens could be successfully fractured. 11 fractures were classified as type 23C3.2 and one was classified as type 23C3.3, as additional fracture of diaphysis occurred. Subclassification according to the four-corner concept showed all fractures to be type C. A concomitant ulnar styloid fracture was observed in 4 cases. Furthermore, all cases showed at least one fragment involving the sigmoid notch. There was no statistically significant correlation found regarding Hounsfield Units (HU) and age (p value 0.402), as well as HU and required kinetic energy (p value 0.063). A high energetic impulse induced by a custom-made drop-test bench can successfully simulate realistic distal radius fractures in cadaveric specimens with intact soft tissue. Furthermore, these pre-fractured specimens can be utilized in surgical education to provide a teaching experience as realistic as possible without harming living patients.

A prospective study on clinical and functional outcome of fracture distal end radius managed by volar plate

Introduction: Fracture of distal end radius are one of the most common skeletal injuries encountered in the orthopaedic practice. There are various modalities of treatment but plating allows secure internal fixation with resultant early return of wrist function by directly restoring the anatomy. The purpose of this study was to evaluate the clinical and functional outcome of the surgical management of intra-articular fractures of distal radius by ORIF with volar plate. Materials and Methods: It was a prospective study in which 25 patients with intra-articular distal radius fracture were managed primarily by ORIF with volar plate whose screws were multidirectional. The clinical and functional outcome was assessed using Gartland and Werley score, and Mayo Wrist score respectively.Results: The study included 25 patients, 19 males and 6 females aged from 21 to 70 years with mean of 38 years. Ulnar styloid fracture was present in 6 patients and DRUJ instability was present in 4 patients. The average duration of follow-up was 7 months ranged from 1-15 months. Using Gartland and Werley 92% had excellent to good result while 79% had excellent to good functional outcome according to Mayo score.Conclusions: Early Primary fixation of the distal radius fractures is important for good functional outcome and to avoid complication of prolonged immobilization, which facilitates early return to regular activities.

Radiographic Healing and Functional Outcomes of Untreated Ulnar Styloid Fractures Following Volar Plate Fixation of Distal Radius Fractures: A Prospective Analysis

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.

Prevalence of triangular fibrocartilage complex injuries in patients with distal radius fractures: a 3.0T magnetic resonance imaging study

ObjectiveThis study was performed to determine the prevalence of triangular fibrocartilage complex (TFCC) injuries as shown by 3.0T magnetic resonance imaging (MRI) in patients with distal radius fractures.MethodsIn total, 57 patients with distal radius fractures underwent 3.0T MRI examinations to observe the incidence of TFCC injuries after manual reduction and cast fixation. The fracture type was categorized by the AO classification, and the TFCC injury pattern was evaluated using the Palmer classification. The correlation between the location of the TFCC injury and the distal radius fracture pattern, distal radioulnar joint instability, or ulnar styloid fracture was analyzed.ResultsFifty-five TFCC injuries were diagnosed. There was no significant relationship between the TFCC injury pattern and the type of distal radius fracture, distal radioulnar joint instability, or ulnar styloid fracture.ConclusionsThis study revealed a high prevalence of TFCC injuries in patients with distal radius fractures. The 3.0T MRI examination helps to assess TFCC injuries in patients with distal radius fractures.Clinical Trial RegistrationChiCTR1800017101.

Cannulated screw internal fixation for the treatment of ulnar styloid base fracture

Objective To explore the operative method and clinical efficacy of cannulated screw in the treatment of ulnar styloid base fracture. Methods From May 2015 to November 2017, 19 patients with ulnar styloid base fractures were treated by internal fixation with cannulated screw. Results All the patients were follow-up for 4 to 32 months with an average of 20 months. All the incisions achieved primary healing. X-ray showed that ulnar styloid fractures achieved bony healing. The healing time ranged from 1.0 to 1.5 months with an average of 1.2 months. No wrist ulnar pain and movement limitation occurred in all the cases. According to Garland and Werley scoring, the excellent and good rate of the wrist function was 100%. Conclusion The cannulated screw for the treatment of ulnar styloid base fracture has strong compressive force on the fracture end with firm fixation, which can promote early movement and recovery of wrist joint function. Key words: Fractures,bone; Treatment outcome; Cannulated screw; Ulnar styloid