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Afifi A, Mansour A. Is it necessary to fix basal fractures of the ulnar styloid after anterior plate fixation of distal radius fractures? A randomized controlled trial. J Hand Surg Eur Vol 2022; 48:544-550. [PMID: 36448506 DOI: 10.1177/17531934221140730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
The purpose of this study was to investigate the necessity for surgical fixation of basal fractures of the ulnar styloid without distal radioulnar joint (DRUJ) instability, after stabilization of associated distal radial fractures using an anterior plate. This single-centre, prospective, randomized controlled trial, conducted between 2015 to 2021, included 43 patients in each study arm who were randomized to either fixation (Group A) or non-operative treatment (Group B) of the ulnar styloid. The mean follow-up period was 24 months (SD 5.2) in Group A and 23.9 months (SD 5.5) in Group B. At the final follow-up, patients were evaluated by the Disabilities of the Shoulder, Arm, and Hand (DASH) score, the Modified Mayo Wrist Score (MMWS), the visual analogue scale (VAS) for pain, the grip strength, wrist range of motion. The DASH score was 6 (SD 2.6) in Group A and 6 (SD 2.4) in Group B; the MMWS was 87 (SD 5.6) in Group A and 87 (SD 5.6) in Group B; and the grip strength was 88% (SD 9.4) in Group A and 87% (SD 7.7) in Group B. In conclusion, fixation of basal ulnar styloid fractures is not mandatory if the DRUJ is stable after rigid fixation of the associated fracture of the distal radius.Level of evidence: II.
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Affiliation(s)
- Ahmed Afifi
- Hand and Microsurgery Unit, Department of Orthopedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman Mansour
- Hand and Microsurgery Unit, Department of Orthopedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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Nuelle JAV. Editorial Commentary: Symptomatic Distal Radioulnar Joint Instability After Distal Radius Fracture Fixation: Improved Outcomes With Arthroscopic Management Are Still Possible After a Trial of Nonoperative Treatment. Arthroscopy 2022; 38:1154-1155. [PMID: 35369918 DOI: 10.1016/j.arthro.2022.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 02/02/2023]
Abstract
The literature to guide clinical-decision making for the treatment of symptomatic distal radioulnar joint instability in the setting of distal radius fracture is mixed, with some advocating for surgical treatment at the time of fracture fixation and others reporting acceptable clinical outcomes with conservative management. Given this, it can be challenging to determine which treatment strategy to employ for each individual patient. For injuries that are the result of high-energy trauma or when there is persistent instability lasting 6 months or longer after fracture fixation, surgical intervention may be needed. However, a period of conservative treatment does not appear to result in poorer outcomes.
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Meng H, Yan JZ, Wang B, Ma ZB, Kang WB, Liu BG. Influence of volar margin of the lunate fossa fragment fixation on distal radius fracture outcomes: A retrospective series. World J Clin Cases 2021; 9:7022-7031. [PMID: 34540957 PMCID: PMC8409212 DOI: 10.12998/wjcc.v9.i24.7022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/13/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Distal radius fractures accompanied by the volar margin of the lunate fossa (VMLF) lesions are often overlooked or inadequately reduced in clinical practice.
AIM To investigate the impact of VMLF fragment in distal radius fractures on the stability and function of the wrist joint.
METHODS This was a retrospective study of patients with distal radius fractures who underwent surgical treatment between January 2013 and December 2017. The patients were divided into two groups according to whether the VMLF fragments were fixed or not. X-rays and computed tomography were performed before surgery, immediately postoperatively, and at 1, 3, and 6 mo to measure the scapholunate angle, radiolunate angle, capitolunate angle, and effective radiolunate flexion (ERLF). The Mayo wrist score and disabilities of the arm, shoulder, and hand (DASH) score were determined at 1 year.
RESULTS Thirty-five patients were included. There were 15 males and 20 females. Their mean age was 52.5 ± 14.3 (range: 19-70) years. There were 38 wrists (17 on the left side, 15 on the right, and three bilateral; 16 in the fixed group, and 22 in the unfixed group). The interval between trauma and surgery was from 1 h to 1 mo. The incidence of postoperative wrist instability in the unfixed group (86.4%) was higher than in the fixed group (25.0%) (P ≤ 0.001). Ten patients had ERLF > 25° in the unfixed group and none in the fixed group (P = 0.019). The Mayo wrist score was 94 ± 5.7 in the fixed group and 68 ± 15.1 in the unfixed group (P < 0.001). The DASH score was 4.6 ± 2.5 in the fixed group and 28.5 ± 19.5 in the unfixed group (P < 0.001).
CONCLUSION Injuries of VMLF, even small fractures, might damage the radial-lunar ligament, leading to postoperative wrist instability, sagittal force line imbalance, and poor recovery of wrist joint function.
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Affiliation(s)
- Hua Meng
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Jia-Zhi Yan
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Bing Wang
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Zong-Bo Ma
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Wei-Bo Kang
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Bao-Ge Liu
- Department of Orthopedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
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Abstract
In this article, we discuss the incidence and types of injuries to the distal radioulnar joint (DRUJ) that occur in the setting of a distal radius fracture. We review the anatomy of the distal radioulnar joint, which is critical to understanding its biomechanics, and how injury could cause symptomatic incongruency and instability. We highlight how patients with an injury to the distal radioulnar joint might present both at the time of injury and after treatment of a distal radius fracture, the appropriate workup, the available treatment options, and the evidence-based literature.
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Affiliation(s)
- Christina Nypaver
- Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - David J Bozentka
- Department of Orthopaedic Surgery, University of Pennsylvania, Penn Presbyterian Medical Center, 3737 Market Street, Philadelphia, PA 19104, USA
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Sochol KM, Nicholson LT, Ghiassi A. Ulnocarpal-Spanning Plate Fixation as a Novel Technique for Complex Distal Ulna Fracture: A Case Report. JBJS Case Connect 2020; 10:e2000190. [PMID: 32960016 DOI: 10.2106/jbjs.cc.20.00190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE The patient was a 60-year-old woman with a comminuted, open distal radius and distal ulna metadiaphyseal fracture. After fixation of the distal radius, the distal ulna was unstable and crepitant with rotation and anteroposterior translation. Because of limited bone stock and poor soft tissue, we spanned the distal ulna using a wrist spanning plate. This was removed at 6 weeks postoperatively. She healed and was satisfied with her outcomes. CONCLUSION This case describes the original use of a wrist spanning plate for a complex distal ulna fracture. Ulnocarpal-spanning plate fixation provides an alternative to traditional methods of fixation.
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Affiliation(s)
- Kristen M Sochol
- 1Department of Orthopedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
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Katt B, Seigerman D, Lutsky K, Beredjiklian P. Distal Radius Malunion. J Hand Surg Am 2020; 45:433-442. [PMID: 32220492 DOI: 10.1016/j.jhsa.2020.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 02/02/2023]
Abstract
Malunion remains the most common complication of nonsurgical treatment of fractures of the distal radius and represents a common clinical entity. Symptomatic treatment often involves corrective osteotomy. Surgical correction is a challenging problem with unpredictable clinical outcomes. Prevention of malunion of a distal radius fracture is the best course of action. With maintenance of volar cortical contact and the use of volar fixed-angle devices, bone grafting may not be necessary in certain cases of malunion correction. New technologies such as 3-dimensional modeling and computer-generated osteotomy guides are likely to have a positive impact on the outcomes of surgical treatment.
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Affiliation(s)
- Brian Katt
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, PA.
| | - Daniel Seigerman
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, PA
| | - Kevin Lutsky
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, PA
| | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, PA
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Lutsky KF, Lucenti L, Beredjiklian PK. Outcomes of Distal Ulna Fractures Associated With Operatively Treated Distal Radius Fractures. Hand (N Y) 2020; 15:418-421. [PMID: 30417702 PMCID: PMC7225889 DOI: 10.1177/1558944718812134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The purpose of this study was to report outcomes in patients with nonstyloid distal ulna fractures treated in conjunction with open reduction internal fixation (ORIF) of distal radius fractures. Methods: A retrospective review of all patients who had undergone ORIF of a distal radius fracture over a 5-year period at a single institution was performed. Radiographic review was performed to identify patients with a concomitant fracture of the distal ulna. Radiographs were examined to determine whether and how the distal ulna fracture was stabilized and to assess healing of the distal ulna. Range of motion (ROM) was determined by review of the patients' charts. All skeletally mature patients with distal ulna fractures (not including isolated styloid fractures) undergoing surgical fixation of the distal radius fracture were included. Patients were excluded if follow-up was inadequate. There were 172 fractures of the distal ulna meeting the inclusion criteria. Seven patients were excluded. There were 91 patients treated without ulna fixation (ulna-no) and 74 patients treated with ulna fixation (ulna-yes). Results: Seventy-two (97%) of the ulna-yes patients healed. All patients in the ulna-no group healed. The only significant difference in ROM was in pronation, although the magnitude of this difference was relatively small. Conclusions: Fractures of the distal ulna have high rates of healing and result in equivalent motion regardless of whether the distal ulna is treated operatively. Routine surgical fixation of concomitant distal ulna fractures during distal radius ORIF does not appear to be necessary.
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Affiliation(s)
- Kevin F. Lutsky
- The Rothman Institute, Philadelphia, PA, USA,Kevin F. Lutsky, The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
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8
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Jochen-Frederick H, Pouyan Y, Khosrow BA, Christoph H, Berthold B, Ulrich K, Thomas K. Long-term functional outcome and patient satisfaction after ulnar head resection. J Plast Reconstr Aesthet Surg 2016; 69:1417-23. [PMID: 27325514 DOI: 10.1016/j.bjps.2016.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 05/10/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIM Resection of the ulnar head (Darrach procedure) is still frequently performed in patients suffering from posttraumatic osteoarthritis of the distal radioulnar joint (DRUJ). Ulnar impingement syndrome is sometimes observed with subsequent poor functional outcome. Here, we present a long-term follow-up study after Darrach procedure to evaluate functional results, pain relief, and patient satisfaction. METHODS Thirty-seven patients after ulnar head resection who were treated in our clinic between 2006 and 2012 were invited for follow-up investigation. Follow-up included radiologic outcomes, objective measures (active range of motion (AROM) and grip strength), the patients' individual perception of disability (pain, visual analog scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and patient-rated wrist evaluation score (PRWE)). RESULTS A total of 25 patients with 27 operated wrists were available for clinical evaluation and radiologic follow-up. The AROM of the treated wrists averaged 145.7° (89.7% of the contralateral side) for pronation and supination. The average VAS decreased from 6.5 to 2.3 postoperatively. Mean grip strength was 12.4 kg (57.1%). Patients showed satisfying results with an average PRWE of 42 and an average DASH of 25.5. Radiographic radioulnar convergence did not correlate with clinical symptoms. Overall, patient satisfaction was high and 22 patients (88%) would choose to undergo the operation again. CONCLUSIONS In patients with posttraumatic and chronic DRUJ osteoarthritis, the Darrach procedure leads to satisfactory long-term results especially concerning mobility and sustainable pain relief. Symptomatic ulnar impingement and persistent pain of the ulnar stump are rare sequelae of this procedure.
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Affiliation(s)
- Hernekamp Jochen-Frederick
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University Heidelberg, Germany
| | - Yary Pouyan
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University Heidelberg, Germany
| | - Bigdeli Amir Khosrow
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University Heidelberg, Germany
| | - Hirche Christoph
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University Heidelberg, Germany
| | - Bickert Berthold
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University Heidelberg, Germany
| | - Kneser Ulrich
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University Heidelberg, Germany
| | - Kremer Thomas
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University Heidelberg, Germany.
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Kasapinova K, Kamiloski V. The correlation of initial radiographic characteristics of distal radius fractures and injuries of the triangular fibrocartilage complex. J Hand Surg Eur Vol 2016; 41:516-20. [PMID: 26763270 DOI: 10.1177/1753193415624669] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 09/16/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED Our purpose was to determine the correlation of initial radiographic parameters of a distal radius fracture with an injury of the triangular fibrocartilage complex. In a prospective study, 85 patients with surgically treated distal radius fractures were included. Wrist arthroscopy was used to identify and classify triangular fibrocartilage complex lesions. The initial radial length and angulation, dorsal angulation, ulnar variance and distal radioulnar distance were measured. Wrist arthroscopy identified a triangular fibrocartilage complex lesion in 45 patients. Statistical analysis did not identify a correlation with any single radiographic parameter of the distal radius fractures with the associated triangular fibrocartilage complex injuries. The initial radiograph of a distal radius fracture does not predict a triangular fibrocartilage complex injury. LEVEL OF EVIDENCE III.
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Affiliation(s)
- K Kasapinova
- Department of Traumatology, University Surgery Clinic, 'St. Naum Ohridski', Skopje, Republic of Macedonia
| | - V Kamiloski
- Department of Traumatology, University Surgery Clinic, 'St. Naum Ohridski', Skopje, Republic of Macedonia
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10
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Liu J, Wu Z, Li S, Li Z, Wang J, Yang C, Yu L, Chen D. Should distal radioulnar joint be fixed following volar plate fixation of distal radius fracture with unstable distal radioulnar joint? Orthop Traumatol Surg Res 2014; 100:599-603. [PMID: 25168452 DOI: 10.1016/j.otsr.2014.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 12/16/2013] [Accepted: 02/20/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Distal radioulnar joint (DRUJ) instability often accompanies distal radial fractures. The goal of this study was to investigate whether DRUJ should be fixed to prevent recurrent DRUJ instability in distal radius fracture patients with unstable DRUJ following open reduction and volar plate fixation of the radius. METHODS A retrospective chart review was performed on forty-nine consecutive patients presenting distal radius fracture who were diagnosed with distal radioulnar instability after radius fixation with volar plate. Group one consisted of 24 patients whose DRUJs were fixed in neutral for 6 weeks with 1∼2 Kirschner wires (8 cases combined with casting), whereas group two consisted of 25 patients without DRUJ fixation. All patients had radiographic evaluation of their wrist and DRUJ for stabilities and underwent functional evaluation using modified Gartland and Werley demerit scoring system (GW score). RESULTS All patients were followed-up for an average of 15 months (12-24 months) after surgery. No significant difference was noted between the two groups with respect to gender, age, fracture types and damage types (no noteworthy medical comorbidities in either group). At the latest follow-up, patients in both groups had comparable grip strength, wrist motion, and visual analogue scale (VAS) and GW scores. Only one patient (2.4%) demonstrated DRUJ chronic instability, but did not require any additional surgery. CONCLUSION The results suggest that in patients with distal radius fractures, fixation of unstable DRUJs in neutral for 6 weeks does not have an advantage over non-fixation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- J Liu
- Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 200072, Shanghai, PR China
| | - Z Wu
- Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 200072, Shanghai, PR China
| | - S Li
- Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 200072, Shanghai, PR China.
| | - Z Li
- Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 200072, Shanghai, PR China
| | - J Wang
- Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 200072, Shanghai, PR China
| | - C Yang
- Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 200072, Shanghai, PR China
| | - L Yu
- Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 200072, Shanghai, PR China
| | - D Chen
- Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 200072, Shanghai, PR China
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Katerina Kasapinova K, Kamiloski V. Analysis of the Arthroscopically Diagnosed Soft-Tissue Injuries Associated With the Distal Radius Fractures. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: The aim of this study was to analyze the frequencies of these soft-tissue injuries and to describe the arthroscopic technique used for their diagnosis.METHODS: The prospective study included 85 patients with operatively treated distal radius fracture. Wrist arthroscopy was used to identify the associated lesions of triangular fibrocartilage complex (TFCC), scapholunate ligament (SL) and lunitriquetral ligament (LT), extrinsic ligaments, and chondral lesions.RESULTS: Wrist arthroscopy identified TFCC injury in 72.9%, SL injury in 65.9%, LT injury in 17.7%, extrinsic ligaments in 49.4% and chondral lesion in 30.6% of the patients. 87.1% of the patients had at least one of the major structures injured (TFCC, SL or LT). The presence of the ulnar styloid fractures significantlly correlated with with the associated LT lesion, with the LT lesion type, and with the lesion of both SL and LT ligament. If the distal radius fracture was intraarticular there was no correlation with the finding of any associated soft-tissue lesion.CONCLUSIONS: The frequency of the associated soft-tissue lesions in distal radius fractures is high. Ulnar styloid fracture was identified as risk factor for associated LT lesion, as well as combined lesion of both scapholunate and luntriquetral ligament.
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Chen YX, Zheng X, Shi HF, Wangyang YF, Yuan H, Xie XX, Li DY, Wang CJ, Qiu XS. Will the untreated ulnar styloid fracture influence the outcome of unstable distal radial fracture treated with external fixation when the distal radioulnar joint is stable. BMC Musculoskelet Disord 2013; 14:186. [PMID: 23758986 PMCID: PMC3686660 DOI: 10.1186/1471-2474-14-186] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 06/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ulnar styloid is an important supportive structure for the triangular fibrocartilage complex. However, it remains inconclusive whether or not a fractured ulnar styloid should be fixed in an unstable distal radius fracture (DRF) with a stable distal radioulnar joint (DRUJ). The purpose of this study is to evaluate the effect of an untreated ulnar styloid fracture on the outcome of unstable DRF treated with transarticular external fixation when the DRUJ is stable. METHODS 106 patients with an unstable DRF and a stable DRUJ were included in this study following external fixation. The patients were divided into the non-fracture, the tip-fracture and the base-fracture groups according to the location of the ulnar styloid fracture at the time of injury. Postoperative evaluation included the range of wrist motion, the radiological index, the grip strength, the PRWE-HK scores, the wrist pain scores, and the instability of DRUJ at the external fixator removal time, three months postoperatively and the final follow-up visit. RESULTS The patients were followed for 12 to 24 months (15 months in average). Sixty-two of 106 patients (58%) had ulnar styloid fracture and 16 patients (26%) showed radiographic evidence of union of ulnar styloid fractures at the final follow-up visit. No significant difference in the radiological findings, the range of wrist motion, the grip strength, the PRWE-HK scores, and the wrist pain scores among three patient groups was detected at the external fixator removal time, three months postoperatively, or the final follow-up visit. Six of the 106 patients (5.7%) complained of persistent ulnar-side wrist pain during daily activities. One patient (0.9%) showed a positive sign in a stress-test, three patients (2.8%) showed a positive sign in a provocative-test, and five patients (4.7%) showed a positive sign in a press-test. There was no significant difference in the percentages of patients who complained of persistent ulnar-side wrist pain or showed a positive sign in the physical examination of the distal radioulnar joint among the three groups at the final follow-up time points. CONCLUSION When the DRUJ is stable, an untreated ulnar styloid fracture does not affect the wrist outcome of the patient with an unstable DRF treated with external fixation.
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Affiliation(s)
- Yi-xin Chen
- Department of Orthopaedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
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Lee SK, Kim KJ, Park JS, Choy WS. Distal ulna hook plate fixation for unstable distal ulna fracture associated with distal radius fracture. Orthopedics 2012; 35:e1358-64. [PMID: 22955402 DOI: 10.3928/01477447-20120822-22] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The significance of distal ulna fractures is often undermined, which can result in inadequate treatment compared with fractures of the radius, the ulna's larger counterpart. However, little guidance exists in the current literature on how to manage distal ulna head or neck fractures and intra-articular ulna head fractures. Therefore, the purpose of this retrospective study was to evaluate the outcomes of distal ulna hook plate fixation for the treatment of an unstable distal ulna fracture associated with a distal radius fracture. Twenty-five patients with unstable distal ulna fractures who underwent stable fixation for an associated distal radius fracture were included in the study. All patients achieved satisfactory reduction and bony union. Average final motion was as follows: wrist flexion, 72° (range, 60°-85°); extension, 69° (range, 65°-80°); pronation, 77° (range, 55°-95°); supination, 82° (range, 65°-90°); ulnar deviation, 35° (range, 15°-50°); and radial deviation, 24° (range, 10°-40°). Average postoperative grip strength was 28 kg (range, 22-30 kg) and was 91% (range, 71%-100%) in the cases in which the dominant hand was injured and 80% (range, 65%-100%) in the cases in which the nondominant hand was injured. Average postoperative modified Mayo wrist score and Disabilities of the Arm, Shoulder and Hand score was 87 points (range, 65-100 points) and 14 points (range, 0-54 points), respectively. Chronic instability of the distal radioulnar joint was not encountered in any patient. Thus, the study demonstrated that distal ulna hook plate fixation for the treatment of unstable distal ulna fractures can achieve healing with good alignment, satisfactory function, and minimal transient morbidity.
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Affiliation(s)
- Sang Ki Lee
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea.
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14
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Abstract
During the last two decades, increased knowledge of functional anatomy and pathophysiology of the triangular fibrocartilage complex (TFCC) have contributed to a change in surgeons' perspective toward it. The earlier concept of the TFCC as the "hammock" structure of the ulnar carpus has updated to the "iceberg" concept, whereby the much larger "submerged" part represents the foveal insertions of the TFCC and functions as the stabilizer of the distal radioulnar joint and the ulnar carpus, thus lending it greater functional importance. This article presents an algorithm of the treatment of traumatic peripheral TFCC tear based on clinical, radiological, and arthroscopic findings.
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Abstract
The stabilizing constraints of the distal radioulnar joint (DRUJ) include its bony geometry and the surrounding soft tissue support. Given the shallow nature of the sigmoid notch, reconstruction of the palmar and dorsal ligamentous sleeve provides the best solution for restoring stability in cases of chronic DRUJ instability. The pertinent anatomy, indications, contraindications, soft tissue stabilizing procedures, and rehabilitation for the management of chronic DRUJ instability are highlighted in this review.
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Affiliation(s)
- Sanjeev Kakar
- Division of Hand Surgery, Department of Orthopaedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
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17
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Abstract
Distal radius malunions are a common cause of patient morbidity. This review of the literature surrounding distal radius malunion covers the demographics, pathologic anatomy, and indications for surgery, surgical techniques, and salvage options. Particular emphasis is placed on subject areas that have not been reviewed as extensively in previous articles, including: intra-articular malunion, computer-assisted techniques, bone graft alternatives, and volar fixed-angle plate osteosynthesis.
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Abstract
Traumatic injuries of the distal radioulnar joint (DRUJ) may give rise to complex wrist pathologies. Substantial ongoing disability can arise should these injuries go unrecognized resulting in sub-optimal treatment and lack of appropriate rehabilitation. Injuries of the DRUJ may occur in isolation but more commonly are found with a fracture of the radius. These challenging DRUJ injuries may be simple or complex (irreducible or severe instability), acute or chronic. An adequate knowledge of the stabilizers of the DRUJ is essential in understanding treatment options. Traumatic instability of the DRUJ is reviewed and the anatomy and stabilizing factors are discussed. An algorithm to guide selection of treatment options in complex cases is presented.
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Affiliation(s)
- Jonathan S Mulford
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada M4N 3M5
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Kim JK, Koh YD, Do NH. Should an ulnar styloid fracture be fixed following volar plate fixation of a distal radial fracture? J Bone Joint Surg Am 2010; 92:1-6. [PMID: 20048089 DOI: 10.2106/jbjs.h.01738] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ulnar styloid fractures often occur in association with distal radial fractures. The purpose of this study was to determine whether an associated ulnar styloid fracture following stable fixation of a distal radial fracture has any effect on wrist function or on the development of chronic distal radioulnar joint instability. METHODS One hundred and thirty-eight consecutive patients who underwent surgical treatment of an unstable distal radial fracture were included in this study. During surgery, none of the accompanying ulnar styloid fractures were internally fixed. Patients were divided into nonfracture, nonbase fracture, and base fracture groups, on the basis of the location of the ulnar styloid fracture, and into nonfracture, minimally displaced (< or =2 mm), and considerably displaced (>2 mm) groups, according to the amount of ulnar styloid fracture displacement at the time of injury. Postoperative evaluation included measurement of grip strength and wrist range of motion; calculation of the modified Mayo wrist score and Disabilities of the Arm, Shoulder and Hand score; as well as testing for instability of the distal radioulnar joint at a mean of nineteen months postoperatively. RESULTS Ulnar styloid fractures were present in seventy-six (55%) of the 138 patients. Forty-seven (62%) involved the nonbase portion of the ulnar styloid and twenty-nine (38%) involved the base of the ulnar styloid. Thirty-four (45%) were minimally displaced, and forty-two (55%) were considerably (>2 mm) displaced. We did not find a significant relationship between wrist functional outcomes and ulnar styloid fracture level or the amount of displacement. Chronic instability of the distal radioulnar joint occurred in two wrists (1.4%). CONCLUSIONS An accompanying ulnar styloid fracture in patients with stable fixation of a distal radial fracture has no apparent adverse effect on wrist function or stability of the distal radioulnar joint.
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Affiliation(s)
- Jae Kwang Kim
- Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, 911-1, Mok-6-dong, Yangcheon-gu, Seoul, 158-710, South Korea.
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Souer JS, Ring D, Matschke S, Audige L, Marent-Huber M, Jupiter JB. Effect of an unrepaired fracture of the ulnar styloid base on outcome after plate-and-screw fixation of a distal radial fracture. J Bone Joint Surg Am 2009; 91:830-8. [PMID: 19339567 DOI: 10.2106/jbjs.h.00345] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The impact of an unrepaired fracture of the ulnar styloid base on recovery after internal fixation of a fracture of the distal part of the radius is uncertain. We evaluated a series of patients with an internally fixed fracture of the distal part of the radius to test the hypothesis that there is no difference in wrist motion or function scores between those with an untreated fracture of the ulnar styloid base and those with no ulnar fracture. METHODS Two cohorts of seventy-six matched patients, one with a fracture of the ulnar styloid base and the other with no ulnar fracture, were retrospectively analyzed by examining data gathered in a prospective study of plate-and-screw fixation of distal radial fractures. Patients were matched for age, sex, AO fracture type, and injury mechanism. The two cohorts were analyzed for differences in motion, grip strength, pain, the Gartland and Werley score, the DASH (Disabilities of the Arm, Shoulder and Hand) score, and the SF-36 (Short Form-36) score at six, twelve, and twenty-four months postoperatively. In a second analysis, sixty-four patients with <2 mm of displacement of a fracture of the ulnar styloid base were compared with forty-nine patients with greater displacement. Differences between cohorts and within cohorts over time were determined with use of regression analysis and the likelihood ratio test. RESULTS No significant differences were found between patients with an unrepaired fracture of the ulnar styloid base and those with no ulnar fracture at any of the follow-up intervals. However, a trend was observed toward less grip strength at six months (71% [of that on the contralateral side] compared with 79%; mean difference, -8% [95% confidence interval=-15.3% to -0.6%]; p=0.03) and less flexion (54 degrees compared with 59 degrees ; mean difference, -5 degrees [95% confidence interval=-11.7 degrees to -0.8 degrees ]; p=0.02) and ulnar deviation (32 degrees compared with 36 degrees ; mean difference, -4 degrees [95% confidence interval=-7 degrees to -0.1 degrees ]; p=0.05) at twenty-four months after surgery in patients with an untreated fracture of the ulnar styloid base. There were no significant differences with regard to any tested outcome measure between the patients with >or=2 mm of displacement of an unrepaired fracture of the ulnar styloid base and those with less displacement. CONCLUSIONS An unrepaired fracture of the base of the ulnar styloid does not appear to influence function or outcome after treatment of a distal radial fracture with plate-and-screw fixation, even when the ulnar fracture was initially displaced >or=2 mm.
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Affiliation(s)
- J Sebastiaan Souer
- Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA
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Chloros GD, Wiesler ER, Poehling GG. Current concepts in wrist arthroscopy. Arthroscopy 2008; 24:343-54. [PMID: 18308188 DOI: 10.1016/j.arthro.2007.10.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Revised: 10/25/2007] [Accepted: 10/26/2007] [Indexed: 02/02/2023]
Abstract
The purpose of this article is to review the recent literature on arthroscopic treatment of distal radius fractures (DRFs), triangular fibrocartilage complex injuries, intercarpal ligament injuries, and ganglion cysts, including the use of electrothermal devices. A major advantage of arthroscopy in the treatment of DRFs is the accurate assessment of the status of the articular surfaces and the detection of concomitant injuries. Nonrandomized studies of arthroscopically assisted reduction of DRFs show satisfactory results, but there is only 1 prospective randomized study showing the benefits of arthroscopy compared with open reduction-internal fixation. Wrist arthroscopy plays an important role as part of the treatment for DRFs; however, the treatment for each practitioner and each patient needs to be individualized. Wrist arthroscopy is the gold standard in the diagnosis and treatment of triangular fibrocartilage complex injuries. Type 1A injuries may be successfully treated with debridement, whereas the repair of type 1B, 1C, and 1D injuries gives satisfactory results. For type 2 injuries, the arthroscopic wafer procedure is equally effective as ulnar shortening osteotomy but is associated with fewer complications in the ulnar positive wrist. With interosseous ligament injuries, arthroscopic visualization provides critical diagnostic value. Debridement and pinning in the acute setting of complete ligament tears are promising and proven. In the chronic patient, arthroscopy can guide reconstructive options based on cartilage integrity. The preliminary results of wrist arthroscopy using electrothermal devices are encouraging; however, complications have been reported, and therefore, their use is controversial. In dorsal wrist ganglia, arthroscopy has shown excellent results, a lower rate of recurrence, and no incidence of scapholunate interosseous ligament instability compared with open ganglionectomy. Arthroscopy in the treatment of volar wrist ganglia has yielded encouraging preliminary results; however, further studies are warranted to evaluate the safety and efficacy of arthroscopy.
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Affiliation(s)
- George D Chloros
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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Abstract
Traumatic injuries of the distal radioulnar joint (DRUJ) may give rise to complex wrist pathologies. Substantial ongoing disability can arise should these injuries go unrecognized resulting in sub-optimal treatment and lack of appropriate rehabilitation. Injuries of the DRUJ may occur in isolation but more commonly are found with a fracture of the radius. These challenging DRUJ injuries may be simple or complex (irreducible or severe instability), acute or chronic. An adequate knowledge of the stabilizers of the DRUJ is essential in understanding treatment options. Traumatic instability of the DRUJ is reviewed and the anatomy and stabilizing factors are discussed. An algorithm to guide selection of treatment options in complex cases is presented.
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Affiliation(s)
- Jonathan S Mulford
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, MG301, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5
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Slagel BE, Luenam S, Pichora DR. Management of post-traumatic malunion of fractures of the distal radius. Orthop Clin North Am 2007; 38:203-16, vi. [PMID: 17560403 DOI: 10.1016/j.ocl.2007.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Distal radius malunions are a common cause of patient morbidity. This review of the literature surrounding distal radius malunion covers the demographics, pathologic anatomy, and indications for surgery, surgical techniques, and salvage options. Particular emphasis is placed on subject areas that have not been reviewed as extensively in previous articles, including: intra-articular malunion, computer-assisted techniques, bone graft alternatives, and volar fixed-angle plate osteosynthesis.
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Affiliation(s)
- Bradley E Slagel
- Division of Orthopaedic Surgery, Kingston General Hospital, Room 9-311, 76 Stuart Street, Queen's University, Kingston, Ontario, K7L 2V7, Canada
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24
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Abstract
Comminuted fractures of the distal end of the
radius are caused by high-energy trauma and present as
shear and impacted fractures of the articular surface of the
distal radius with displacement of the fragments. The force
of the impact and the position of the hand and carpal bone
determine the pattern of articular fragmentation and their
displacement and the amount and the extent of frequent
concommitant ligament and carpal bone injury. The result
of the osseous lesion in comminuted fractures was termed
"pilon radiale", which emphasizes the amount of damage
to the distal radius and the difficulties to be expected in
restoring the articular congruity. Besides this the additional
injury, either strain of disruption of the ligaments and
the displacement of the carpus and/ or the triangular fibrocartilage
complex will equally influence the functional
outcome. This review will expand on the relevant anatomy,
correct classification and diagnosis of the fracture, diagnostic
tools and operative treatment options. Current treatment
concepts are analysed with regard to actual literature
using the tools of evidence based medicine criteria. A new
classification of severely comminuted distal radius fractures
is proposed using CT data of 250 complex intraarticular
radius fractures. Finally a standardized treatment protocol
using external fixation in combination with minimal
invasive internal osteosynthesis is described.
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Walz M, Kolbow B, Möllenhoff G. Distale Ulnafraktur als Begleitverletzung des körperfernen Speichenbruchs. Unfallchirurg 2006; 109:1058-63. [PMID: 17123046 DOI: 10.1007/s00113-006-1185-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The distal radius is one of the commonest sites of fracture, and this injury is sometimes associated with fracture of the distal ulna. In recent years, surgical treatment of distal radius fractures has consisted increasingly in internal fixation with locking plates followed by early functional postoperative treatment. The associated injury to the distal ulna has so far not received much attention in the literature. Various techniques have veen described for its treatment: Kirscher wire fixation, tension band wiring, and internal fixation with screws and plates. Following positive results with elastic stable intramedullary nailing (ESIN) in the treatment of shaft fractures in children this technique was also applied in in fractures in adults (forearm, clavicle). Use of this technique for stabilisation of distal ulnar fractures has not previously been reported. In the course of a prospective longitudinal study (EBM level II), in 26 patients with an average age of 73.6 (42-88 years), bone healing in anatomical position was achieved in all cases within 6-12 weeks after closed reduction and anterograde ESIN with subsequent treatment that did not involve immobilization. No length differences of more than 2 mm and no functionally relevant deviations of the ulnar axis were observed. Apart from 3 cases of nail perforation at the distal end of the ulna, which had no clinical manifestations, there were no complications. ESIN offers a minimally invasive option for the treatment of unstable fractures of the distal ulna associated with distal radius fractures; it allows functional aftertreatment and can be regarded at least as an alternative to open reduction with internal fixation.
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Affiliation(s)
- M Walz
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Herford, Schwarzenmoorstrasse 70, 32049, Herford, Germany.
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Abstract
Arthroscopy has the advantage of providing a direct and accurate assessment of the articular surfaces and detecting the presence of injuries associated with distal radius fractures. Current indications, although numerous and potentially expanding, also are controversial. This report presents a global view of the current status of arthroscopy in the management of distal radius fractures. The rationale of arthroscopic treatment, the available evidence, and finally the diagnosis and treatment are discussed.
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Abstract
The treatment of distal radius fractures continues to be fraught with complications. The more widespread use of internal fixation and supple-mental bone grafting with external fixation has decreased the incidence of malunions from closed-cast treatment and percutaneous pinning, but increased the risk of the complications specific to surgical intervention. Careful diagnosis, surgical planning, surgical technique, and postoperative rehabilitation can help optimize outcome in these difficult fractures.
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Affiliation(s)
- Andrew P Gutow
- Department of Orthopedics, Stanford University, Stanford, CA 94305, USA; Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, CA 94301, USA
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