Effect of internal fixation of ulnar styloid process base fracture on wrist function

doi:10.12307/2023.735

Abstract

Abstract: BACKGROUND: Fractures of the distal radius and the base of the styloid process of the ulna are common in clinical practice. Because of the double destruction of the fracture and the surrounding ligaments and cartilage, the distal radioulnar joint is unstable. In the past, insufficient attention was paid to the fracture of the base of the styloid process of the ulna, which often led to complications such as wrist joint pain and limited range of motion after surgery, and the treatment plan was controversial.
OBJECTIVE: To investigate the effect of internal fixation on the function of the wrist joint with fracture of ulnar styloid process base in distal radius fracture.
METHODS: Clinical data of 40 patients with traumatic distal radius fractures accompanied by ulnar styloid process base fractures treated with concurrent surgical treatment in Dongying People’s Hospital from June 2018 to December 2020 were retrospectively analyzed. All distal radius fractures were operated by open reduction and internal fixation. According to whether the fracture of the base of ulnar styloid process was treated surgically or not, the patients were divided into the internal fixation group and control group, with 20 cases in each group. The measured data of X-ray films were collected before and 6 and 12 months after operation, and the ulnar inclination, palmar tilt and radial height of the two groups were compared. The ranges of motion of the wrist joint in dorsal extension, palmar flexion, radial deviation, ulnar deviation, pronation and supination directions were recorded 1 year after operation. The effect was evaluated with the Gartland-Werley scoring standard.
RESULTS AND CONCLUSION: At the follow-up after operation, palmar tilt, ulnar inclination and radial height of the wrist joint of the two groups were all better than those before operation (P < 0.05), but the difference was not statistically significant between the two groups (P > 0.05). The ranges of motion of the wrist joint in dorsal extension, palmar flexion, radial deviation, ulnar deviation, pronation and supination directions were better in the internal fixation group than those in the control group 1 year after operation (P < 0.05). The excellent and good rate of the internal fixation group (90%) 1 year after the operation was significantly higher than that of the control group (55%) (P < 0.05). These findings conclude that one-stage internal fixation of ulnar styloid process base fracture during the operation of distal radius fracture is conducive to further recovery of wrist function.

Key words: ulnar styloid process base fracture, distal radius fracture, wrist joint function, therapeutic result, distal radioulnar joint, triangular fibrocartilage complex

CLC Number:

Cheng Shuai, Jiang Shanyong, Lu Jianshu, Ji Xubin. Effect of internal fixation of ulnar styloid process base fracture on wrist function[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(36): 5840-5844.

Figures/Tables 6

References

[1] 郑上团,吴斗,郝海虎,等.桡骨远端骨折的治疗进展[J].中华骨科杂志,2016,36(5):314-320.
[2] 姜保国,张殿英,付中国,等.桡骨远端骨折的治疗建议[J].中华创伤骨科杂志,2010,12(11):1053-1056.
[3] WYSOCKI RW, RUCH DS. Ulnar styloid fracture with distal radius fracture. J Hand Surg Am. 2012;37(3):568-569．
[4] 徐春归,张积森,许新忠,等.合并尺骨茎突骨折对桡骨远端骨折钢板内固定术后功能恢复的影响[J].临床骨科杂志,2019,22(4): 466-470.
[5] 吴佳俊,王子平,易存国,等.桡骨远端骨折内固定治疗预后与尺骨茎突骨折的相关临床分析[J].生物骨科材料与临床研究,2018, 15(6):52-54.
[6] 张俊,厉国定,尹伟忠,等.尺骨茎突骨折与否及不同分型对桡骨远端骨折术后疗效的影响[J].中国骨与关节损伤杂志,2019,34(3): 321-323.
[7] 董加纯,尹望平,陈延超,等.尺骨茎突骨折固定与否对桡尺远侧关节旋转稳定性的影响[J].中华手外科杂志,2015,31(4):266-268.
[8] KIM JK, YUN YH, KIN DJ, et al. Comparison of United and Nonunited Fractures of the Ulnar Styloid Following Volar-Plate Fixation of Distal Radius Fractures. Injury. 2011;42(4):371-375.
[9] CHEN AC, CHIU CH, WENG CJ, et al. Early and late fixation of ulnar styloid base fractures yields different outcomes. J Orthop Surg Res. 2018;13(1):193-197.
[10] 张超,谢雪涛,胡顺东,等.尺骨茎突骨折对桡骨远端骨折内固定术后腕关节功能的影响[J].国际骨科学杂志,2016,37(4):264-266．
[11] GARTLANDJJ JR, WERLEY CW. Evaluation of healed Collesfractures. J Bone Joint Surg Am. 1951;33:895-907．
[12] ADAMS BD. Effects of radial deformity on distal radioulnar joint mechanics. J Hand Surg Am. 1993;18(3):492-498．
[13] 李晓,侯忠军,于胜军,等.探讨具有手术指征的特殊类型的尺骨茎突骨折[J].实用手外科杂志,2017,31(1):108-109.
[14] 关启.切开复位内固定治疗桡骨远端骨折不同类型尺骨茎突骨折的最终效果[J].临床研究,2019,28(11):66-67.
[15] FRYKMAN G. Fracture of the distal radius including sequelae -shoulder -hand -finger syndrome，disturbance in the distal radio -ulnar jointand impairment of nerve function：a clinical and experimental study．Acta Orthop Scand. 1967;108(Suppl):3．
[16] Lindau T, Hagherg L, Adlercreutz C, et al. Distal radioulnar instability is an independent worsening factor in distal radial fractures. Clin Orthop Relat Res. 2000;(376):229-230.
[17] 郑晓勇,任昕宇,赵东升,等.尺骨茎突基底部骨折的治疗方式对腕关节功能的影响[J].创伤外科杂志,2014,1(1):14-16.
[18] 刘小智,宋坤修,马丙栋,等.桡骨远端骨折桡侧移位对桡尺远侧关节稳定性的影响[J].中华手外科杂志,2019,35(6):4.
[19] 危涛,王勤业,罗亚平,等.两种内固定治疗桡骨远端骨折伴尺骨茎突基底部骨折的疗效比较[J].临床骨科杂志,2021,24(2):257-260.
[20] MAY MM, LAWTON JN, BLAZAR PE. Ulnar styloid fractures associ-ated with distal radius fractures:incidence and implications for distal radioulnar joint instability. J Hand Surg Am. 2002;27(6):965-971.
[21] LUTSKY KF, LUCENTI L, BEREDJIKLIAN PK. Outcomes of distal ulna fractures associated with operatively treated distal radius fractures. Hand (N Y). 2020;15(3):418-421.
[22] 徐春归,张积森,许新忠,等.合并尺骨茎突骨折对桡骨远端骨折钢板内固定术后功能恢复的影响[J].临床骨科杂志,2019,22(4): 466-470.
[23] LICHTMAN DM, BINDRA RR, BOYER MI, et al. American academy of orthopaedic surgeons clinical practice guideline on: the treatment of distal radius fractures. J Bone Joint Surg Am. 2011;93(8):775-778.
[24] 周强,陆骅,王占朝,等.生物可吸收张力带治疗尺骨茎突骨折的评价[J].中国组织工程研究,2013,17(25):4733- 4738.
[25] PARDLWALA D, PRABHU V, DUDHMIWALA G, et al. The AO distal locking aimingdevice: an evaluation of efficacy and learning CRllve. Injury. 2001;32:713.