桡骨远端骨折合并尺骨茎突基底部骨折致急性桡尺远侧关节不稳定的手术疗效分析

目的:探讨桡骨远端骨折合并尺骨茎突基底部或隐窝处骨折引起急性开放性桡尺远侧关节不稳定的手术指征和治疗方法。方法:自2014年1月至2019年6月我科对13例桡骨远端骨折、合并尺骨茎突基底部或隐窝处骨折的桡尺远侧关节急性不稳定患者进行一期手术治疗,通过掌侧钢板复位固定桡骨骨折后,术中对比健侧进行桡尺远侧关节冲击试验。如果...     

斜T形锁定钢板治疗桡尺骨远端不稳定型骨折

目的评价用“AO”的桡骨远端斜T形锁定钢板系统固定桡骨远端骨折疗效。方法6例有移位桡骨远端粉碎骨折,且伴有下尺桡关节损伤的不稳定型骨折,其中1例为双手骨折,共7侧。按1upiter分类：关节内三部分4例,关节内四部分3例。采用掌侧Henry路,切开复位,锁定钢板,螺钉内固定,修复下尺桡背侧韧带、三角纤维软骨,并固定尺骨茎突。结果随访8～14个月,平均1．01年。按Gartland—werler腕关节评分：优4例,良2侧,可1侧,优良率85．7％。结论对于有移位桡骨远端粉碎骨折,且伴有下尺桡关节损伤的不稳定性骨折,采用掌侧Henry2v路,切开复位,锁定钢板,螺钉内固定,修复下尺桡背侧韧带、三角纤维软骨,并固定尺骨茎突是一种理想的治疗方法。     

桡骨远端骨折对下尺桡关节稳定性的影响

目的:分析桡骨远端骨折后腕部功能与下尺桡关节稳定性之间的关系,探讨桡骨远端骨折影响下尺桡关节稳定性的原因.方法:85例桡骨远端骨折患者,男27例,女58例;年龄17～74岁,平均42.3岁.采用手法复位石膏外固定治疗,伤后6～9个月(平均6.7个月)摄腕关节正侧位X线CR片,检查下尺桡关节稳定性,采用Sarmiento改艮的Gartland-Werley评分系统(GW评分)时腕部进行功能评估.结果:85例获得6～9个月随访,平均6.7个月.19例有下尺桡关节不稳定.下尺桡关节不稳与放射学检查下尺桡关节情况之间无明显的联系.下尺桡关节不稳的患者GW评分平均为12.37±5.899,稳定的患者GW评分平均为6.85±4.222,差异有统计学意义.尺骨茎突是否骨折其GW评分差异无统计学意义.是否有尺骨茎突骨折其下尺桡关节不稳发生率比较差异无统计学意义.结论:明显成角或短缩畸形的桡骨远端骨折损伤三角纤维软骨复合体可能是造成下尺桡关节不稳、影响腕部功能的主要原因.伴随桡骨远端骨折的尺骨茎突骨折对下尺桡关节稳定性无明显影响.     

桡骨远端骨折合并移位型尺骨茎突骨折的手术治疗研究

背景:在对桡骨远端骨折合并移位型尺骨茎突骨折患者的处理中,尺骨茎突是否需要手术固定尚存争议。目的:比较两种不同手术方法固定桡骨远端骨折合并移位型尺骨茎突骨折的临床疗效。方法:2007年5至2010年3月手术治疗桡骨远端骨折合并移位型尺骨茎突骨折(HauckⅡ型,移位>2mm)39例,其中单纯桡骨远端切除复位内固定(单纯桡骨固定组)22例,桡骨远端骨折固定合并尺骨茎突骨折切开复位内固定(尺桡骨远端固定组)17例,术后指导功能锻炼。结果:所有患者均获得随访。随访时间为12～26个月,平均19个月。术后3个月两组的腕关节Gartland-Werley评分无统计学差异(P>0.05);术后1年两组的腕关节Gartland-Werley评分、掌屈及尺偏功能无统计学差异(P>0.05),尺侧疼痛评分有显著性差异(P<0.05)。结论:对于桡骨远端骨折合并移位型尺骨茎突骨折患者而言,桡骨远端骨折固定合并尺骨茎突骨折切开复位内固定优于单纯桡骨远端切除复位内固定。     

桡骨远端骨折对下尺桡关节稳定性的影响

目的:分析桡骨远端骨折后腕部功能与下尺桡关节稳定性之间的关系,探讨桡骨远端骨折影响下尺桡关节稳定性的原因。方法:85例桡骨远端骨折患者,男27例,女58例;年龄17~74岁,平均42.3岁。采用手法复位石膏外固定治疗,伤后6~9个月(平均6.7个月)摄腕关节正侧位X线CR片,检查下尺桡关节稳定性,采用Sarmiento改良的Gartland-Werley评分系统(GW评分)对腕部进行功能评估。结果:85例获得6~9个月随访,平均6.7个月。19例有下尺桡关节不稳定。下尺桡关节不稳与放射学检查下尺桡关节情况之间无明显的联系。下尺桡关节不稳的患者GW评分平均为12.37±5.899,稳定的患者GW评分平均为6.85±4.222,差异有统计学意义。尺骨茎突是否骨折其GW评分差异无统计学意义。是否有尺骨茎突骨折其下尺桡关节不稳发生率比较差异无统计学意义。结论:明显成角或短缩畸形的桡骨远端骨折损伤三角纤维软骨复合体可能是造成下尺桡关节不稳、影响腕部功能的主要原因。伴随桡骨远端骨折的尺骨茎突骨折对下尺桡关节稳定性无明显影响。     

术中行下尺桡关节稳定性检查对于尺骨茎突骨折治疗的临床意义

目的分析术中行下尺桡关节稳定性检查对于尺骨茎突骨折治疗的临床意义。方法选取本院63例桡骨远端骨折伴尺骨茎突骨折患者,完成各组病例的桡骨远端骨折经钢板螺钉内固定术,根据术中术后对尺骨茎突治疗处理的结果进行分组,分为固定组32例,不固定组31例,其中固定组又分为内固定组17例,外固定组15例;不固定组术中术后尺骨茎突骨折未予任何处理,内固定组术中尺骨茎突给予内固定术治疗,外固定组术后尺骨茎突给予石膏托外固定治疗,比较固定组与不固定组、内固定组和外固定组之间的疗效与PRWE评分。结果固定组的优良率(93.75%)高于不固定组(74.19%),P0.05;内固定组与外固定组的优良率(94.12%与93.33%)相近,P0.05。固定组术后3、6个月的PRWE评分(50.47±6.36分、35.23±5.90分)均低于不固定组(63.52±8.29分、54.04±7.18分),P0.05;内固定组与外固定组术后3、6个月的PRWE评分(51.43±6.30分、36.01±5.89分与49.89±5.70分、35.18±5.94分)相近,P0.05。结论完成桡骨远端骨折内固定术的同时,术中下尺桡关节稳定性检查对于尺骨茎突骨折的治疗具有指导性意义:下尺桡关节不稳定的尺骨茎突骨折,需行内固定治疗才能获得较好疗效,而下尺桡关节稳定的尺骨茎突骨折,行外固定治疗同样能达到内固定治疗的效果。给予尺骨茎突骨折相应的固定,可提高桡骨远端骨折经钢板螺钉内固定术的治疗效果,有助于关节功能恢复。     

尺骨茎突骨折对外固定架治疗桡骨远端骨折的影响

目的探讨尺骨茎突骨折对外固定支架治疗不稳定性桡骨远端骨折疗效的影响。方法回顾性分析118例不稳定性桡骨远端骨折患者的随访资料。根据尺骨茎突骨折情况分为:A组(尺骨茎突基底部骨折)、B组(尺骨茎突尖部骨折)、C组(无尺骨茎突骨折)。所有患者均采用外固定支架治疗,尺骨茎突骨折不做任何治疗,术后6~8周拆除外固定支架,平均随访15.3个月,终末随访时行影像学参数(掌倾角、尺偏角、桡骨高度)、腕关节活动度(掌屈、背伸、尺偏、桡偏、旋前、旋后)及Gartland-Werley评分测定。结果终末随访时三组病例之间在影像学参数、腕关节活动度及Gartland-Werley评分方面均未发现统计学差异。结论采用外固定支架治疗不稳定性桡骨远端骨折时,若下尺桡关节稳定,对伴有的尺骨茎突骨折可不做任何治疗。     

动静结合治疗尺桡骨远端骨折200例体会

我院1972～1990年并收治新鲜尺桡骨远端骨折200例,平均年龄38.5岁.其中Colles骨折134例(67%)、桡骨远端骨骺分离28例(14%)、桡骨远端粉碎性骨折合并下尺桡关节分离21例(10.5%)、桡骨远端骨折合并尺骨茎突骨折17例(8.5%).采用手法复位小夹板固定,固定后即行计划性自动功能锻炼.解除固定后加活血汤熏洗,收到显著疗效.现介绍如下.     

改良经皮克氏针固定治疗桡骨远端骨折

目的:探讨改良经皮克氏针固定治疗桡骨远端骨折的手术方法与疗效。方法:桡骨远端骨折患者43例,男19例,女24例;年龄14~71岁,平均39岁。采用改良经皮克氏针固定法治疗,骨折复位成功后经皮打入3枚克氏针固定。其一从桡骨远折端桡侧进针,从桡骨远折端尺侧出针,克氏针继续进针穿过尺骨下端;其二从桡骨茎突斜行进针经骨折线从桡骨近折端尺侧出针,克氏针继续进针穿过尺骨;其三从桡骨近折端桡侧斜行进针经骨折线从桡骨远折端尺侧出针。结果:术后随访6~12个月,43例均获临床愈合,无骨折再移位。按Aro评定标准:优13例,良23例,可5例,差2例。结论:改良经皮克氏针固定治疗桡骨远端骨折固定牢固,损伤小,有利于骨折愈合和关节功能恢复。     

桡骨远端骨折合并尺骨茎突骨折内固定术后掌倾角和尺偏角改变对桡骨短缩的影响

目的探讨桡骨远端骨折合并尺骨茎突骨折内固定术后掌倾角和尺偏角改变对桡骨短缩的影响。方法采用回顾性病例对照研究的方法, 分析2018年2月—2022年1月北京市大兴区人民医院手术治疗的84例桡骨远端骨折合并尺骨茎突骨折患者的临床资料。根据尺骨茎突骨折是否手术固定分为两组:尺骨茎突骨折给予手术固定的18例患者为固定组, 尺骨茎突骨折未进行手术固定的66例患者为非固定组。比较两组患者的围手术期指标(手术时间、术中出血量、手术切口长度), 腕关节功能指标[Gartland-Werley评分、上肢功能(DASH)评分、前臂旋转、尺偏、掌屈、桡偏、背伸、握力]和并发症发生情况(骨不连、骨溶解、腕尺侧疼痛、内固定失效、下尺桡不稳、术后感染)。通过广义估计方程(GEE)分析两组患者的掌倾角、尺偏角及桡骨远端距离多时点变化情况。随访12个月, 依据末次随访时桡骨短缩距离是否≥4 mm, 将所有患者分为未短缩组(桡骨短缩距离<4 mm, n=61)和短缩组(桡骨短缩距离≥4 mm, n=23)。通过Logistic回归分析评价术后桡骨短缩的影响因素。结果与非固定组相比, 固定组患者的Gartland...     

Dorsal dislocation of the ulnar styloid and extensor carpi ulnaris tendon into the distal radioulnar joint: the empty sulcus sign

Two cases of distal radioulnar joint (DRUJ) disruption and diastasis secondary to distal radial fractures were associated with displacement of the ulnar styloid and extensor carpi ulnaris (ECU) into the DRUJ. Both cases had a palpable empty ECU tendon sulcus. In one case surgical exploration revealed that the ulnar styloid, triangular fibrocartilage, and extensor carpi ulnaris tendon had dislocated into the DRUJ as a unit. The end result was good. In the second case lack of recognition and reduction of the ECU tendon and ulnar styloid led to persistent subluxation and diastasis. The end result was poor. Early recognition of the dislocation of the ulnar and ECU into the DRUJ and their significance may avoid poor results.     

Editorial Commentary: Guidelines for Wrist Triangular Fibrocartilage Complex Foveal Tears: A Compass for a Broad Voyage

The ulnar head attachment of triangular fibrocartilage complex is divided into 2 sections: the distal radioulnar ligament consists of superficial and deep bundles on both the palmar and dorsal sides, which attach at the fovea and the base of the ulnar styloid. A tear on the ulnar side of triangular fibrocartilage complex inevitably occurs at these attachments. Both magnetic resonance imaging and distal radioulnar joint (DRUJ) arthroscopy are crucial. DRUJ arthroscopy can clarify the tear location. An ulnar styloid tear can be treated by capsular repair. However, a foveal tear should be reattached to the fovea because this tear could cause gross DRUJ instability. There are several ways to reattach the bundles to the fovea, including single- or double-tunnel or bone anchors, and open versus arthroscopic.     

Isolated radial shaft fractures are more common than Galeazzi fractures

PURPOSE: In contrast to isolated diaphyseal fractures of the ulna (so-called night-stick fractures), isolated fractures of the radial diaphysis generally are expected to have associated injury of the distal radioulnar joint (DRUJ), the so-called Galeazzi fracture. This study retrospectively reviewed isolated fractures of the radial diaphysis in a large cohort of patients to determine how often such fractures occur without DRUJ injury METHODS: Thirty-six patients with fracture of the radius without fracture of the ulna were followed up for at least 6 months after injury. Injury of the DRUJ was defined as more than 5 mm of ulnar-positive variance on radiographs taken before any manipulative or surgical reduction. All of the fractures were treated with plate and screw fixation (8 with autogenous bone grafting) and all healed. Patients with DRUJ injury had either temporary pinning or immobilization of the DRUJ or surgical fixation of a large ulnar styloid fracture. Patients without DRUJ injury were mobilized within 2 weeks. RESULTS: Nine patients had dislocation of the DRUJ, 4 with large ulnar styloid fractures. Among the remaining 27 patients 1 had displacement of the proximal radioulnar joint noted after surgery, leading to a secondary procedure for radial head resection. The functional results were satisfactory or excellent in all but 2 patients with functional limitations related to central nervous system injury. No patient had DRUJ dysfunction at the final follow-up evaluation. CONCLUSIONS: Isolated fractures of the radial diaphysis are more common than true Galeazzi fractures. Surgeons should take great care not to overlook injury to the distal or proximal radioulnar joint in association with isolated diaphyseal fractures of the radius; however, fractures without identifiable radioulnar disruption can be treated without specific treatment of the DRUJ and with immediate mobilization. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.     

Irreducible chronic palmar dislocation of the distal radioulnar joint--a case report.

We report a rare case of irreducible chronic palmar dislocation of the distal radioulnar joint (DRUJ). This case showed that the dislocated ulnar head was impacted to the palmar cortex of the radius probably due to the dynamic force of the pronator quadratus muscle. Re-attachment of the ulnar styloid and partial resection of the ulnar head were necessary to make the reduction of the DRUJ possible. The continuity of the radioulnar ligament to the ulnar head was restored and the stability of DRUJ was maintained after reduction.     

An analysis of causes and treatment outcome of chronic wrist pain after distal radial fractures

Healed distal radial fractures are frequently complicated by chronic wrist pain which is multifactorial and can be debilitating. An accurate delineation of the pathoanatomy is the key for successful treatment. This study reviewed 22 patients who had surgical treatment between 1997 and 2001 for chronic wrist pain after distal radial fracture. Four patterns of pathoanatomy were identified: (1) ulnar impaction caused by radial malunion and shortening; (2) ulnar styloid non-union; (3) triangular fibrocartilage complex (TFCC) tears with or without distal radioulnar joint (DRUJ) instability; and (4) intercarpal ligament injuries and chondral lesions. Surgical treatment directed towards identified abnormalities gave satisfactory outcome. At six months after surgery the mean functional score improved 36%, mean pain score decreased 50%, mean grip strength improved 25%, and 64% of patients returned to work.     

Management of the distal radioulnar joint and ulnar styloid fracture

Fractures of the distal radius and ulnar styloid have the potential to disturb the normal function of the distal radioulnar joint (DRUJ), resulting in loss of motion, pain, arthritis, or instability. The DRUJ can be adversely affected by several mechanisms, including intra-articular injury with step-off, shortening, and angulation of an extra-articular fracture; injury to the radioulnar ligaments; ulnar styloid avulsion fracture; and injury of secondary soft tissue stabilizers. This article discusses the management of the DRUJ and ulnar styloid fracture in the presence of a distal radius fracture.     

Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability

Ulnar-sided injuries of the wrist have received more attention recently for their potential negative impact on the outcome of distal radius fractures. Radiographs and medical records were retrospectively reviewed for 166 distal radius fractures treated during a 1-year interval. Distal radius fractures were classified according to the AO system, and accompanying ulnar styloid fractures were evaluated for both size and displacement. Each distal radius fracture was also evaluated for radiographic and clinical evidence of distal radioulnar joint instability. The distribution of ulnar styloid fractures was not random; greater than one third involved the base. All distal radius fractures complicated by distal radioulnar joint instability were accompanied by an ulnar styloid fracture. A fracture at the ulnar styloid's base and significant displacement of an ulnar styloid fracture were found to increase the risk of distal radioulnar joint instability.     

Does an ulnar styloid fracture interfere with the results of a distal radius fracture?

Background  

The ulnar styloid is a supportive structure for the capsular ligament complex of the distal radioulnar joint. The relation between fractures of the ulna and distal radius is not clear, especially in regard to whether ulnar fractures predict worse outcomes for distal radius fractures. The objective of this study was to analyze the influence of ulnar styloid fractures in patients with reducible and unstable distal radius fractures.     

Ulnar styloid process nonunion and outcome in patients with a distal radius fracture: A meta-analysis of comparative clinical trials

PurposeThere is no consensus on the relation between ulnar styloid process nonunion and outcome in patients with distal radius fractures. The aim of this study was to analyze whether patient-reported outcome is influenced by the nonunion of the accompanying ulnar styloid fracture in distal radius fracture patients.MethodsA meta-analysis of published studies comparing outcomes after distal radius fractures with a united versus a non-united ulnar styloid process was performed. In addition, if provided by the authors, the raw data of these studies were pooled and analysed as one study. The outcome measures of the analyses included patient-reported outcome, functional outcome, grip-strength, pain, and distal radioulnar joint (DRUJ) instability.ResultsData from six comparative studies were included, concerning 365 patients with a distal radius fracture. One hundred and thirty-five patients with an ulnar styloid union were compared with 230 patients with a nonunion of the ulnar styloid. No significant differences were found between groups regarding any outcome measure.ConclusionBased on this meta-analysis, there is no relation between the nonunion of the ulnar styloid process and function in patients with a distal radius fracture.