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

Comparative analysis of tension band wiring and hook plate fixation in ulnar styloid fractures: a focus on fracture type

INTRODUCTION

Various surgical techniques for ulnar styloid fractures (USFs) fixation have recently been developed, the actual clinical outcomes have not been discussed in detail. This study aimed to compare the outcomes of tension band wiring (TBW) and hook plate fixation in the treatment of USFs and to explore effective management strategies for these fractures.

MATERIALS AND METHODS

We retrospectively reviewed 109 patients with styloid process fractures from March 2016 to July 2020. Among them, patients aged 21-75 years who required surgical intervention for USFs with distal radioulnar joint (DRUJ) instability, with or without accompanying distal radius fracturs (DRFs), were included. The patients were treated with either TBW (group T) or hook plate fixation (group P). The fractures were classified into four types based on their location and complexity. Postoperative assessments were conducted using radiographic analysis to monitor fracture healing. Clinical evaluations, including range of motion (ROM), grip strength, and patient-reported outcomes using the disabilities of the arm, shoulder, and hand scores and the visual analog scale for pain, were performed, at multiple time points up to a year after surgery. Statistical analyses were conducted to compare outcomes across fracture types and treatment methods.

RESULTS

Osseous union was achieved in 96% of the patients. Specifically, the time to union in types 3 and 4 fractures was significantly shorter in group P than in group T. Functionally, ROM assessments showed similar flexion-extension in both groups but better pronation-supination in group T. Grip strength and patient-reported outcomes did not show significant differences between the groups.

CONCLUSIONS

TBW offers slight ROM benefits for type 2 USFs, whereas hook plate fixation provides superior stability for complex types 3 and 4 USFs. Despite the minimal differences in ROM, the enhanced advantages of the hook plate fixation make it the preferred choice for severe fractures, ensuring faster healing.

Comparative Analysis of Clinical Effects of the Cable-Pin System and Kirschner Wire Tension Band (TBW) Internal Fixation in the Treatment of the Olecranon Fracture

Objective

To explore the clinical effects of the cable-pin system and Kirschner wire tension band (TBW) internal fixation in the treatment of the olecranon fracture.

Methods

Fifty patients with an olecranon fracture were treated in our hospital from April 2018 to March 2020. Patients were randomly divided into control and study groups. The control group was fixed with TBW, and the study group was fixed with the cable-pin system. The operation, the circumference difference between the injured limb and the healthy limb, the VAS score, the excellent and good rate, the recovery of the range of motion of the joint 1 year after operation, and the incidence of postoperative adverse reactions were compared between the two groups.

Results

In terms of the operation of the two groups, the operation time, intraoperative blood loss, healing time, incision drainage, and hospital stay in the study group were lower than those in the control group (P < 0.05). In the comparison of the circumference difference between the injured limb and the healthy limb, there was no significant difference between the two groups before operation (P > 0.05), but the circumference difference between the injured limb and the healthy limb in the study group was lower than that in the control group at 24 hours, 72 hours, 7 days, and 30 days after operation, and the difference was statistically significant (P < 0.05). There was no significant difference in the VAS score between the two groups before operation, but 7-day VAS scores at 12 h, 24 h, and 72 h after operation in the study group were significantly lower than those in the control group (P < 0.05). The excellent and good rate in the study group was excellent in 18 cases, good in 5 cases, fair in 2 cases, excellent in 7 cases, good in 6 cases, fair in 8 cases, and poor in 4 cases in the control group, and the excellent and good rate in the study group (100.00%) was higher than that in the control group (84.00%), and the difference was statistically significant (P < 0.05). The patients in the two groups were followed-up for one year, and there were no shedding cases in the two groups. In terms of the recovery of range of motion one year after operation, the scores of elbow flexion, extension/degree, and elbow function in the study group were higher than those in the control group (P < 0.05), and the difference was statistically significant (P < 0.05). The incidence of postoperative adverse reactions in the study group (4.00%) was significantly lower than that in the control group (28.00%), and the difference was statistically significant (P < 0.05). The incidence of postoperative adverse reactions was significantly lower in the study group (4.00%) than that in the control group (28.00%), and the difference was statistically significant (P < 0.05), while only 1 patient in the study group had chronic pain, while 7 patients in the control group had incision ulcer (1 case), chronic pain (2 cases), and internal fixation loosening (4 cases). The difference was statistically significant (P < 0.05).

Conclusion

The cable-pin system for the treatment of an olecranon fracture has the advantages of simple operation, fast fracture healing time, and low incidence of complications, which is a kind of orthopedic internal fixation consumable material in line with biomechanical requirements of the human body.

Distal Radioulnar Joint, Distal Ulna Injury, and Lunate Facet Considerations in Distal Radius Fractures

Injuries to the distal aspect of the ulna and the distal radioulnar joint (DRUJ) commonly occur concurrently with distal radius fractures. These fractures may also involve the sigmoid notch of the lunate facet of the radius. Each of these structures merits consideration when managing ulnar-sided injuries associated with distal radius fractures. Improper management of distal radioulnar complex injuries may result in limited wrist motion, persistent DRUJ instability, and pain despite successful fracture union. The distal ulna is the keystone of the distal radioulnar articulation. An understanding of the components of the distal radioulnar complex and methods to manage injuries of each of these components contributes to improved functional outcomes by restoring this keystone effect. The classification of distal radioulnar injuries discussed herein provides a framework for understanding the disruption of the ligamentous stabilizers of the DRUJ and identifying residual distal radioulnar instability after fracture fixation. Proper treatment of residual DRUJ instability will restore stability and minimize persistent functional impairment.