Hypertrophic ulnar styloid nonunions

Eleven patients with chronic pain on the ulnar side of the wrist and roentgenographic evidence of a hypertrophic ulnar styloid nonunion were treated with subperiosteal excision of the nonunion fragment. This procedure relieved the localized pain without changing either radiocarpal or distal radioulnar joint stability.     

Evaluation of ulnar styloid length

PURPOSE: General awareness of the ulnar styloid impaction syndrome is low and often is neglected. Radiographic evaluation of the ulnar styloid length generally includes an x-ray of the posteroanterior view. This study analyzed the effect of different radiographic views to assess the length of the ulnar styloid. The ulnar styloid-capitate ratio (SCR) expresses the relative length of the ulnar styloid, and we compare this ratio with the ulnar styloid process index (USPI). METHODS: To evaluate the ulnar styloid and to analyze the effect of different radiographic views on measurement outcome, measurements were performed in 7 different radiographic positions of both wrists of 69 patients. To assess the relative size of the ulnar styloid and its impaction potential the USPI was calculated, re-evaluated, and compared with the SCR, in which the length of the ulnar styloid is divided by the length of the capitate bone. RESULTS: The mean ulnar styloid length in all standard posteroanterior radiographs is 4.4 +/- 1.2 mm. In our population the average USPI was 0.21 +/- 0.11 and the average SCR was 0.18 +/- 0.05. The SCR has a stronger correlation with the length of the ulnar styloid than the USPI. Furthermore this new ratio eliminates differences related to gender, whereas the USPI does not. CONCLUSIONS: To identify ulnar impaction potential we recommend using the USPI, but to compare ulnar styloid between patients we recommend using the SCR obtained from neutral posteroanterior radiographs. For white patients we suggest defining a long ulnar styloid as having an SCR greater than 0.18 +/- 0.05 and/or an overall styloid length greater than 6 mm.     

Morphological variations of the ulnar styloid process

P.A. radiographs of both wrists were taken in 400 normal individuals to study the configuration of the styloid process of the ulna. Five different morphological variations were noticed, the commonest being an elongated process (102 wrists). Medially deviated (41 wrists), parrot beaked (27 wrists) and hypertrophic (16 wrists) patterns were less common. One person had bilateral unfused separate ossification centres for the ulnar styloid. There was no correlation between the length of the styloid process and ulnar variance.     

Radiologic evaluation of the ulnar styloid.

The ulnar styloid (US) architecture was examined radiologically and directly by dissection in 13 cadaver wrists to examine a potential relationship between US shape and US abutment syndrome and to determine an optimal radiographic view that could be used to detect US fractures. A higher incidence of US abutment syndrome in the radially deviated US type was observed by dissection. Radiographs taken at varying shoulder abduction angles suggested that the base of the US and ulnar head are not round. To best evaluate the fovea and the US for possible US fractures, radiographs should be taken with the glenohumeral joint abducted 45 degrees, the elbow flexed 90 degrees, the forearm in neutral rotation, and the x-ray beam directed through the wrist perpendicular to the floor.     

Painful hypertrophic non-union of the ulnar styloid

We report the case of a 16-year-old girl suffering from painful hypertrophic non-union of the ulnar styloid. She fractured the distal end of the radius four years before and had been treated conservatively. The non-union was painful and severely limited the range of movement of the wrist. Excision of the hypertrophied styloid was performed and the patient promptly resumed her activities. We believe this is the first such case reported in an adolescent.     

桡骨远端及尺骨茎突骨折手法整复后尺神经卡压于尺骨茎突骨折端1例

患者,女,54岁,3个月前不慎摔倒,右腕部着地,当即出现右腕肿胀、畸形、功能受限,于当地医院拍片后诊断为“右桡骨远端骨折、右尺骨茎突骨折”,予以骨折手法整复术,石膏托外固定。2个月后去除石膏托行功能锻炼,发现右手尺侧麻木不适,右手无力伴肌萎缩,小鱼际萎缩明显,抓握无力,且症状渐进性加重。在当地医院予以神经营养药物内服治疗,     

Carpal impaction with the ulnar styloid process: treatment with partial styloid resection

Carpal impaction with the ulnar styloid process (stylocarpal impaction) occurs less frequently than with the ulnar head (ulnocarpal impaction), and more commonly develops in wrists with negative ulnar variance. Physical examination, radiographic evaluation, and wrist arthroscopy are all helpful in excluding alternative causes of ulnar wrist pain. When an ulnocarpal stress test elicits pain, and radiographs suggest that this is due to carpal impaction with the ulnar styloid, partial resection of the styloid process provides successful treatment, so long as the insertion of the triangular fibrocartilage at the base of the styloid is not disrupted.     

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.     

累及桡尺远侧关节不稳定的尺骨茎突骨折手术治疗

目的 介绍累及桡尺远侧关节不稳定的桡骨远端合并尺骨茎突骨折的手术指征和治疗方法.方法 2005年1月至2009年6月,对12例桡骨远端骨折合并尺骨茎突骨折的患者,采用克氏针结合张力带钢丝固定尺骨茎突,同时采用骨锚修复下尺桡韧带深层结构在尺骨隐窝的止点,从而稳定桡尺远侧关节.结果 术后12例桡骨远端骨折及尺骨茎突骨折均愈合,术后随访时间为6～18个月.按改良的Mayo腕关节评分标准评定:优4例,良5例,中2例,差1例.结论 尺骨茎突在桡尺远侧关节稳定中起着重要作用,对累及下尺桡韧带结构损伤的尺骨茎突骨折进行固定并重建韧带对稳定桡尺远侧关节有较为重要的作用.     

Impact of ulnar styloid fractures in nonoperatively treated distal radius fractures

Purpose

The effect of an ulnar styloid fracture (USF) on the stability of nonoperatively treated distal radius fractures (DRF) is unknown. The aim of this study was to evaluate the influence of USFs on the dislocation of DRFs treated by closed reduction.

Methods

Standardized radiographs of 100 nonoperatively treated DRFs were evaluated. DRFs with a USF were compared to DRFs without a USF with respect to dorsal tilt, radial inclination, and ulnar variance.

Results

We evaluated the radiographs of 100 DRFs in 99 consecutive patients, of whom 84 were women. An accompanying USF was present in 58 wrists, of which 49 were displaced. On the trauma radiograph, the USF group showed significantly more overall dislocation. After closed reduction, fracture position improved, and no significant differences in dislocation were observed between groups. After a mean of 42 days, radial inclination significantly decreased if a USF was present. When USF displacement was taken into account, significantly more ulnar variance occurred in the displaced USF group on the trauma and follow-up radiograph compared to the nondisplaced USF group and no-USF group.

Conclusions

The results of this study show that presence of a dislocated USF in patients with a DRF is associated with a worse position directly after trauma, and with recurrence of radial shortening after adequate reduction. These results warrant early radiologic follow-up in patients with reduced combined DRFs and USFs in order to evaluate the redislocation of the distal radius. Early detection of redislocation in these combined fractures may induce early surgical intervention.     

尺骨茎突骨折对桡骨远端骨折后腕关节功能的影响

目的通过比较伴或不伴尺骨茎突骨折的桡骨远端骨折患者临床资料,探讨尺骨茎突骨折对桡骨远端骨折后腕关节功能的影响。方法回顾分析2005年2月-2010年5月收治的182例伴或不伴尺骨茎突骨折的桡骨远端骨折患者临床资料,其中75例伴尺骨茎突骨折(A组),107例不伴尺骨茎突骨折(B组)。两组患者性别、年龄、病程、骨折分型等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。A组采用闭合复位小夹板或石膏固定治疗42例,切开复位钢板内固定33例;B组分别为63例及44例。A组尺骨茎突骨折均未作处理。结果两组患者术后均获随访,其中A组平均随访时间为21个月,B组为20个月。切开复位内固定患者术后切口均Ⅰ期愈合。A组4例(5.3%)、B组6例(5.6%)患者出现腕关节尺侧疼痛,发生率比较差异无统计学意义(χ2=0.063,P=0.802)。X线片示两组桡骨远端骨折均愈合,A组愈合时间为(10.9±2.7)周,B组为(11.6±2.3)周,两组差异无统计学意义(t=1.880,P=0.062)。桡骨远端骨折愈合时两组掌倾角、尺偏角及桡骨长度比较,差异均无统计学意义(P>0.05)。末次随访时两组腕关节屈伸、桡尺偏、旋前旋后活动度及手握、捏力均相似(P>0.05)。Gartland-Werley腕关节评分:A组优24例,良43例,可5例,差3例,优良率89.3%;B组优35例,良57例,可10例,差5例,优良率86.0%;两组差异无统计学意义(Z=—0.203,P=0.839)。A组闭合复位外固定及切开复位内固定患者以上评价指标比较,差异均有统计学意义(P<0.05)。结论尺骨茎突骨折对桡骨远端骨折后腕关节功能无明显影响;对于伴尺骨茎突骨折的桡骨远端骨折,桡骨远端骨折解剖复位对腕关节功能的恢复具有重要意义。     

克氏针结合钢丝法治疗尺骨茎突骨折

目的 探讨尺骨茎突骨折的手术方法 及疗效.方法 2001年8月-2006年6月,对56例(58处)尺骨茎突骨折的患者,采用克氏针结合钢丝法进行内固定治疗.结果 术后随访1.5～18个月,平均7个月.X线片显示骨折均完全骨性愈合,55例无腕部慢性疼痛及活动受限,1例有腕部慢性疼痛.结论 应用克氏针结合钢丝法治疗尺骨茎突骨折是理想的治疗方法 ,尤其对预防尺骨远端疼痛,疗效满意.     

Should ulnar styloid be fixed following fixation of a distal radius fracture?,

IntroductionFracture of the base of the ulnar styloid has shown to have higher incidence of TFCC tears and DRUJ instability leading to nonunion and impaired function. Poorer functional outcomes of the distal radius fracture have been attributed to the untreated associated ulnar styloid fractures while some studies have shown no difference. Thus, the treatment remains controversial. However, it has been shown that fractures at the base of the ulnar styloid have a higher incidence of tears in the triangular fibrocartilage complex (TFCC) and instability in the distal radioulnar joint (DRUJ), which can lead to nonunion and impaired function. Despite this, there are currently no studies comparing the outcomes of surgically and conservatively treated patients.MethodsA retrospective study was conducted to analyze the outcomes of intra-articular distal radius fractures associated with base of ulnar fracture treated with distal radius LCP fixation. The study included 14 patients who were treated surgically and 49 patients who were treated conservatively, with a minimum follow-up of 2 years. Radiological parameters such as union and amount of displacement, VAS score for ulnar-sided wrist pain, functional assessment using the modified Mayo score and the quick DASH questionnaire and complications were analyzed.ResultsAt the final follow-up, the mean scores for pain (VAS), functional outcomes (modified Mayo score), disability (QuickDASH score), range of motion, and non-union rate were found to be statistically insignificant (p > 0.05) between the surgically treated and conservatively treated groups. However, patients with non-union had statistically significant higher scores for pain (VAS), greater post-operative displacement of the styloid, poorer functional outcomes, and higher disability (p < 0.05).ConclusionWhile there was no significant difference in ulnar-sided wrist pain and functional outcomes between the surgically treated and conservatively treated groups, the conservatively treated cases had a higher risk of non-union, which can negatively impact functional outcomes. The amount of pre-operative displacement was found to be a key factor in predicting non-union and can be used as a guide for determining the management of this type of fracture.     

桡骨远端骨折钢板内固定治疗桡骨远端骨折时是否合并尺骨茎突骨折对疗效的影响

4项队列研究关注桡骨远端骨折合并尺骨茎突骨折采用钢板内固定治疗时不治疗尺骨茎突骨折对疗效的影响.这4项研究的结论均认为:与不合并尺骨茎突骨折的桡骨远端骨折手术治疗相比,不治疗尺骨茎突骨折并不会对最终疗效产生影响.通过1～2年的随访发现,不论患者是否存在尺骨茎突骨折,疗效均无显著差异.     

尺骨茎突骨折手术与非手术治疗的疗效比较研究

目的 比较尺骨茎突骨折手术治疗与非手术治疗的疗效.方法 尺骨茎突骨折手术治疗组62例(64处),采用克氏针结合钢丝法,术后随访2～18个月,平均8个月;非手术治疗组70例(72处),随访1.5～24个月,平均10个月.采用AO组织的Gartland-Wertey评分方法,根据尺骨茎突骨折愈合情况,对两组病例疗效进行比较.结果 尺骨茎突骨折手术治疗组:优57例,良2例,中2例,差1例,优良率为95.2%;X线片显示术后3个月骨折均达到骨性愈合.尺骨茎突骨折非手术治疗组:优10例,良15例,中18例,差27例,优良率为35.7%;X线片显示伤后1.5个月9例骨折达到骨性愈合,伤后6个月32例骨折畸形愈合,伤后12个月29例尺骨茎突骨折不愈合.两组差异有统计学意义(P＜0.05).结论 尺骨茎突骨折手术治疗在腕关节功能恢复优良率及骨折愈合方面均明显优于非手术治疗.

Abstract：

Objective To compare the clinical outcomes of surgical and non-surgical treatment of ulnar styloid fractures. Methods There were 62 patients (64 sides) that were treated with Kirschner wire and tension band fixation in the surgical group. They were follow-up postoperatively for 2 to 18 months, with an average of 8 months. Seventy patients (72 sides) were non-surgically treated and follow-up for 1.5 to 24 months with an average of 10 months. Gartland and Werley scoring system of the AO Foundation was applied to evaluate the results. Fracture healing was evaluated by X-ray films. Comparison was made between the surgical and nonsurgical groups. Results Results in the surgical group were graded as excellent in 57 cases, good in 2 cases,fair in 2 cases and poor in 1 case. The overall satisfactory rate was 95.2%. X-rays showed that bone union was obtained in all the patients three months after the surgery. Results in the non-surgical group were graded as excellent in 10 cases, good in 15 cases, fair in 18 cases and poor in 27 cases. The overall satisfactory rate was 35.7%. X-rays showed bone union in only 9 cases 1.5 months after the injury, fracture malunion in 32 cases 6 months after the injury, and nonunion in 29 cases even 12 months after the injury. The differences between the two groups were statistically significant. Conclusion From the aspects of wrist function and fracture healing,surgical treatment of ulnar styloid fractures is superior to non-surgical treatment.     

尺骨茎突骨折愈合对桡骨远端骨折术后关节功能影响

目的观察尺骨茎突骨折愈合情况短期内对桡骨远端骨折内固定术后腕关节功能的影响。 方法回顾性分析2012年6月至2013年6月于聊城市中医医院收治的136例单侧不稳定的桡骨远端骨折伴尺骨茎突骨折患者的临床资料,所有患者均采用锁定钢板固定桡骨骨折,根据尺骨茎突骨折愈合情况将患者分为尺骨茎突骨折愈合组(愈合组,n＝43)和尺骨茎突骨折未愈合组(未愈合组,n＝93)。根据术后X线正侧位片测量并记录患者桡骨高度(桡骨茎突与尺骨茎突之差)、掌倾角、尺偏角,评价桡骨骨折复位、愈合情况和尺骨茎突愈合情况,记录腕关节尺侧旋转疼痛的患者数量。末次随访时采用Gartlant-Werley评分和臂肩手功能障碍评分(DASH)评分评估腕关节功能,测定并记录腕关节的活动范围及握力。性别、骨折类型等计数资料比较采用卡方检验,时间、DASH评分等计量资料比较采用t检验。 结果两组患者在年龄、性别、受伤至手术时间、骨折内固定研究学会(AO)骨折分型、受伤侧别和致伤原因方面比较差异无统计学意义(P>0.05)。尺骨茎突骨折愈合组尺侧旋转疼痛有18例(41.9%),而未愈合组有40例(43.0%),差异无统计学意义(χ²＝1.021,P>0.05)。两组患者的住院时间、桡骨骨折愈合时间、掌倾角、尺偏角和桡骨高度方面比较,差异无统计学意义(P>0.05),具有可比性。两组患者背伸、掌曲、桡偏、尺偏、握力和DASH评分、Gartlant-Werley评分和优良率方面比较差异无统计学意义(P>0.05)。 结论尺骨茎突骨折愈合情况在短期内对桡骨远端骨折内固定术后腕关节功能的康复无明显影响。