Ulnar Styloid Process Fracture Research Articles

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 < 0.05). There was no difference in anatomical indicators between the groups before operation and 3 months after operation (P > 0.05). Before operation, there was no difference in the range of motion of the wrist joint between the groups (P > 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 < 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 < −2.0, T-score < −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

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.

[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.

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

Lag Screw Fixation for Treatment of an Ulnar Styloid Process Fracture with Antebrachiocarpal Joint Luxation in a Cat

AbstractFracture of the ulnar styloid process can result in clinically debilitating antebrachiocarpal instability. Previously described repair methods include Kirschner wire and figure of eight tension band wire and/or intramedullary pinning. This case report describes surgical repair of a short oblique ulnar styloid process fracture in a cat using two cortical screws placed in lag fashion. Recheck evaluation confirmed lameness-free full return to function with anatomical fracture healing.

Volar dislocation of distal radioulnar joint with ulnar styloid process fracture

Volar dislocation of distal radioulnar joint with ulnar styloid process fracture

Functional outcomes of distal radius fractures with and without ulnar styloid fractures: a meta-analysis.

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

Effect of ununited fracture of the ulnar styloid process on wrist function following internal fixation of distal radius fracture

Objective To investigate the effect of nonunion of ulnar styloid process fracture on the wrist function following internal fixation of distal radius fracture. Methods From January 2012 to December 2012, 128 patients with distal radius fracture were treated by open reduction and internal fixation (ORIF). They were 41 males and 87 females, aged from 18 to 80 years (average, 53.2 years). The ulnar styloid process fracture united in 41 cases but did not in the other 87 ones. The postoperative radiological parameters, the Gartland-Werley and Disabilities of the Arm, Shoulder and Hand (DASH) scores, ulnar rotation wrist pain, grip strength and ranges of active wrist motion at the final follow-ups were compared between the 2 groups of patients. The 2 groups were compatible in terms of preoperative demographic data (P >0.05). Results All the 128 patients were followed up for 39 months on average (range, from 30 to 46 months). For the fracture union group and the fracture nonunion group, respectively, the fracture healing time was 12.1±1.8 weeks versus 11.8±1.6 weeks; the palmar tilt of the distal radius was 11.0°±2.0° versus 10.3°±1.8°; the ulnar inclination angle was 21.4°±1.8° versus 21.5°±2.1°; the radial height was 10.9±2.4 mm versus 11.2±2.4 mm; the grip strength was 24.1±8.6 kg versus 25.8±8.3 kg; the ranges of active wrist motion between the healthy and affected sides were 4.8°±4.2° versus 4.6°±4.1° at dorsal extension, 4.9°±4.8° versus 5.0°±4.6° at palmar flexion, 2.9°±2.7° versus 2.7°±2.1° at radial deviation and 2.8°±2.6° versus 2.1°±1.9° at ulnar deviation; the Gartland-Werley score was 3.3±3.4 versus 2.5±2.7; the DASH score was 12.3±6.4 versus 13.3±5.5; the ulnar rotation wrist pain was found in 24 and 57 ones. No significant differences were found in all the above indexes between the 2 groups (P >0.05). Conclusion The ununited fracture of the ulnar styloid process may have little effect on the wrist functional recovery following ORIF of the distal radius fracture. Key words: Carpal joints; Fractures, ununited; Fracture fixation, internal

Conservative Treatment Is Sufficient for Acute Distal Radioulnar Joint Instability With Distal Radius Fracture

Treatments for acute distal radioulnar joint (DRUJ) instability with distal radius fracture vary from conservative to operative treatment, although it seems to be no consensus regarding which treatment is optimal. This prospective randomized study was designed to compare the clinical outcomes for operative and conservative treatment of acute DRUJ instability with distal radius fracture, according to the presence or absence and type of ulnar styloid process fracture and the degree of its displacement. Between July 2008 and February 2013, we enrolled 157 patients who exhibited an unstable DRUJ during intraoperative manual stress testing (via the ballottement test) after fixation of the distal radius. Patients were classified according to the type of the ulnar styloid process fracture, using preoperative wrist radiography, and each group was divided into subgroups, according to their treatment method. We then compared the clinical outcomes between the conservative and operative treatments, using their range of motion; Disabilities of the Arm, Shoulder, and Hand score; modified Mayo wrist score; and grip strength. At 3 months after surgery, among patients without ulnar styloid process fracture, the flexion-extension range was 79 ± 15° after supination sugar-tong splinting (group A-1), 91 ± 14° after DRUJ transfixation (group A-2), and 89 ± 10° after arthroscopic triangular fibrocartilage complex repair (group A-3); the operative treatments provided greater joint motion ranges than conservative treatment. The groups with ulnar styloid process fractures at the tip (group B) or base (group C) also exhibited better clinical outcomes after the operative treatments, compared with after the conservative treatment. However, at the final follow-up, groups A-1, A-2, and A-3 exhibited similar flexion-extension ranges (122 ± 25°, 119° ± 18°, and 120° ± 16°, respectively) and modified Mayo wrist scores (87 ± 7, 89 ± 8, and 85 ± 9). Thus, the conservative and operative treatments provided similar long-term outcomes, and similar results were observed for patients with ulnar styloid process fracture at the tip or base. The average splint application period for patients who underwent conservative treatment was 6.6 weeks (range, 4-9 weeks). In our practice, conservative treatment (supination sugar-tong splinting) and surgical treatments provided similar long-term outcomes for acute DRUJ instability with distal radius fracture.

Effect of ulnar styloid fracture on functional outcome of Colle's fractures: a comparative analysis of two groups

Background: The negative impact of ulnar sided injuries on distal radius fractures has opened another field of research and is gaining more attention. The aim of our study is to assess the impact of ulnar styloid process fracture on functional outcome of distal radius fractures managed conservatively. Methods: Radiological and Medical records of 150 patients of distal radius with and without styloid process fractures were retrospectively reviewed. Fractures were classified as per Frykman’s classification and patients were assessed for pain, grip and range of motion in addition to other parameters in Mayo’s wrist score. The instability at distal radioulnar joint was evaluated and compared in two groups. Results: There was a measurable difference in motion, strength, pain, or functional scores between the two groups.  Mean mayo score at final follow up in Group I was 90±5 and in Group II was 80±4 and the difference was statistically significant (P value <0.05). DRUJ instability was noted in 20 % of patients in Group II and most of them were symptomatic. Conclusions: We conclude that presence of a fracture of ulnar styloid process with distal radius fracture results in a weak and painful wrist in a significant number of patients. They should be dealt more vigorously and managed effectively to prevent disabling distal radioulnar joint instability.

An Exceptional Case of Bilateral Radiocarpal Dislocation with Fracture of the Radial Styloid Associated to a Tiered Trauma of the Upperlimb

Radiocarpal dislocation is a particular entity, infrequent, representing only 0.2% of all dislocationsas evidenced by the scarcity of publications, which mainly affects young patients, and most often the result of violent trauma. We reported a case of a 35-year-old male patient who sustained dorsal radiocarpal dislocation after a fall from a high place, with fracture of the radial and ulnar styloid process in both wrists, associated to a tiered trauma of the right upperlimb. He was treated with closed reduction and immobilized by cast for the bilateral radiocarpal dislocation, and treated surgically for the tiered trauma of the upperlimb. The evaluation at 3 months showed favorable results. This case is one of the few similar cases reported because it is an uncommon pathology and it is even less frequent because the injury involves both wrists and the upperlimb.

Bilateral dorsal perilunate dislocation of wrist

We present a case of simultaneous dorsal perilunate dislocation of both wrists, without a history of fall on outstretched hands. In contrast, it appeared that the mechanism was reverse. His hands were held in radial deviation with wrists in full palmar flexion. The forearms were in neutral position and elbows in mid-flexion. The wrists were suddenly and forcibly pronated. The radiographs of both wrists showed dorsal perilunate dislocation with avulsion fracture of the tip of ulnar styloid process and avulsion fracture of posterior horn of lunate. Radial translation of the carpal bones was also noted. The mechanism is proposed and discussed.

The 'β-wire Technique' for the Fixation of Ulnar Styloid Process Fracture - Surgical Technique -

The 'β-wire Technique' for the Fixation of Ulnar Styloid Process Fracture - Surgical Technique -

Triangular Fibrocartilage Complex and Lunotriquetral Ligament Injury of Distal Radius Fracture

Purpose: The purpose of this study was to assess the relationships between the pattern of fractures and associated intra-articular soft tissue injuries. Materials and Methods: We performed a study of 31 patients treated for distal radius fracture. Radiographic evaluation included ulnar styloid process fracture, dorsal anglulation and ulnar variance. We observed TFCC injuries, scapholunate and lunotriquetral ligament injuries by arthroscopy. Results: The incidence of TFCC radial rim tear and lunotriquetral ligament injuries were significantly higher in die punch fractures with lunate facet involvement than in fractures without lunate facet involvement (p0.05). Conclusion: The TFCC radial rim and the lunotriquetral ligament may be injured by axial compression loading of the ulnar head on the triquetrum. TFCC radial rim tear and lunotriquetral ligament injuries must be kept in mind in die punch fractures with lunate facet involvement.

IRREDUCIBLE GALEAZZI FRACTURE-DISLOCATION DUE TO AN AVULSION FRACTURE OF THE FOVEA OF THE ULNA

We report a rare case of Galeazzi fracture-dislocation with an irreducible distal radioulnar joint. The cause of the irreducibility was entrapment of a fragment avulsed from the fovea of the ulna. The patient was successfully treated with open reduction and internal fixation of the radius, ulnar styloid process and avulsed fracture at the fovea of the ulna.