Clinical analysis of prognosis of distal radius fracture treated with internal fixation and ulnar styloid fracture

Objective:To analyze the correlation between the prognosis of distal radius fracture and ulnar styloid fracture with internal fixation.Methods:A total of 22 patients with distal radius fractures admitted to our hospital from January 2017 to December 2019 were selected and divided into a reference group (11 cases, combined) and an observation group (11 cases, not combined) according to whether the patients were complicated with ulnar styloid fractures.Case Description:All patients were treated with internal fixation. Imaging parameters of the wrist (including ulnar Angle, palmaric inclination, radial styloid height, etc.) and range of motion of the wrist were observed before and after the last follow-up of the two groups.Results:Patients in both groups were followed up for 6 to 12 months, and there was no statistical significance in imaging parameters, range of wrist motion and other indexes of postoperative and last follow-up between the two groups (P>0.05).Conclusion:Ulnar styloid fracture has no significant effect on functional recovery in patients with distal radius fracture treated by fixation.

The Critical Size of Ulnar Styloid Fragment for the DRUJ Stability

Background Ulnar styloid fractures can be associated with clinically significant instability of the distal radioulnar joint (DRUJ). However, the exact fragment size that results in DRUJ instability is unknown. Purpose The objective of this study was to determine the critical size of an ulnar styloid fracture that would result in a significant increase in DRUJ translation and forearm rotation. Methods Eight cadaveric specimens were used to investigate the effects of three different ulnar styloid fracture sizes on DRUJ instability: tip fracture, base fracture, and a fracture including the fovea. Forearm rotation and dorsopalmar DRUJ translation were measured after each sequential increase in fracture size. Results Relative to the uninjured state, a significant increase in forearm rotation and dorsopalmar translation was found for all three fractures. However, the fovea fracture showed a statistically significant increase in forearm rotation compared with all other fracture types and a statistically significant increase in total dorsopalmar translation compared with the tip fracture. Conclusion In this study, ulnar styloid fractures involving the fovea resulted in significantly greater DRUJ instability comparted to tip and base fractures alone. This study provides important biomechanical data regarding the critical size of ulnar styloid fractures that result in DRUJ instability and may aid in the surgical decision-making algorithm in these patients.

Ulnar Styloid Fracture Accompanying Distal Radius Fracture Does Not Affect Hand Function, but What About Hand Dexterity?

Introduction Hand dexterity is not addressed in patients with distal radius fracture (DRF) accompanied with ulnar styloid fracture (USF) in literature. This study aimed to determine whether an associated USF following a DRF has any effect on hand dexterity. Materials and Methods Patients diagnosed with DRF were included in the study and were divided into two groups according to the USF presence (USF group and non-USF group). Pain, range of motion, Quick-DASH (Quick-Disabilities of the Arm, Shoulder, and Hand), handgrip and pinch strength, Purdue Pegboard test, and Jebsen Taylor Hand Function test were measured in the sixth month. Results A total of 125 patients, 68 females (54.4%) and 57 males (45.6%) were included in the study. The mean age of the patients was 47.15 ± 13.41 (18–65) years. There were 60 patients (48%) in the USF group and 65 patients (52%) in the non-USF group. No significant difference was found in pain, range of motion, Quick-DASH and handgrip and pinch strength between the groups (p > 0.05). The hand dexterity tests showed no statistically significant difference between the groups in the sixth month (p > 0.05). Discussion Hand function can be determined more accurately by assessing hand dexterity. In this study, it is emphasized that concomitant USF does not lead to poorer hand dexterity.

“Cortical” Wrist Drop due to a Cerebral Peduncle Infarct

Wrist drops are usually due to a peripheral neuropathy affecting the radial nerve. Cortical wrist drops may occur, usually due to a lesion in the contralateral hand area of the motor cortex. We report a unique case of “cortical” wrist drop due to an acute infarction of the contralateral cerebral peduncle. The patient is a 70-year-old gentleman with the vascular factors of hypertension, hyperlipidaemia, and prior cerebellar strokes, who developed sudden onset of right wrist weakness without numbness. Neurological examination showed a right wrist and finger drop. Nerve conduction study of the radial nerve was normal. MRI brain revealed an acute infarct in the medial part of the left cerebral peduncle, extending slightly to the medial thalamus; there were also old medial posterior cerebellar infarcts. Time of flight MR angiography was normal, with hypoplastic right vertebral artery. Echocardiography was normal but for a dilated right atrium. Electrocardiogram was normal, and 24-hour Holter monitoring detected infrequent atrial and ventricular ectopics. X-ray wrist showed an old ulnar styloid fracture. Nerve conduction study of the radial nerve was normal. He was switched from aspirin to clopidogrel and underwent rehabilitation. The cerebral peduncle should not be forgotten when attempting to anatomically localise the site of the lesion when evaluating a patient with a wrist drop.

Relationship between Fracture of the Ulnar Styloid Process and DRUJ Instability: A Biomechanical Study

Background There has been clinical question in the treatment of ulnar styloid fracture with distal radius fracture, surgical fixation of the styloid fragment, or ignorance of the fragment. We examined relationship between size of the ulnar styloid fracture and distal radioulnar joint (DRUJ) stability biomechanically to answer the above clinical question. Methods Changes in the dorsopalmar stiffness of the DRUJ after experimentally simulating in four types of ulnar styloid fractures were examined in cadavers. After tip, middle, base-horizontal, and base-oblique type of styloid fractures were made sequentially, changes in dorsopalmar DRUJ stiffness were measured using the MTS machine in the intact wrist, for each fracture, at 60 degrees pronation, neutral, and 60 degrees supination, respectively. Additional cutting of the radioulnar ligament (RUL) at the fovea was also simulated with the base-horizontal fracture. Results The tip and middle type fractures did not demonstrate significant loss of stiffness compared with the intact. The base-horizontal fracture demonstrated only significant loss of stiffness in the dorsal direction (radius palmar; ulnar dorsal) with forearm in neutral rotation. The base-oblique fracture demonstrated significant loss of dorsopalmar stiffness of the DRUJ. Additional section of the RUL with the base-horizontal fracture induced significant loss of stiffness of the DRUJ compared with the intact. Conclusions Because the RUL originates from the fovea as well as from the base of the ulnar styloid, these results suggest that DRUJ instability closely correlates with how much of the bony fragment includes the originating portions of the RUL. The findings further suggest that larger base-oblique and base-horizontal fragments with resultant DRUJ instability must be reattached, but that even base-horizontal fragment as well as tip and middle ulnar styloid fragment can be ignored when there is no instability.

Patient-reported outcomes after corrective osteotomy for a symptomatic malunion of the distal radius

Aims The primary aim of this study was to describe patient satisfaction and health-related quality of life (HRQoL) following corrective osteotomy for a symptomatic malunion of the distal radius. Methods We retrospectively identified 122 adult patients from a single centre over an eight-year period who had undergone corrective osteotomy for a symptomatic malunion of the distal radius. The primary long-term outcome was the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcomes included the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, the EQ-5D-5L score, complications, and the Net Promoter Score (NPS). Multivariate regression analysis was used to determine factors associated with the PRWE score. Results Long-term outcomes were available for 89 patients (72%). The mean age was 57 years (SD 15) and 68 were female (76%). The median time from injury to corrective osteotomy was nine months (interquartile range (IQR) 6 to 13). At a mean follow-up of six years (1 to 11) the median PRWE score was 22 (IQR 7 to 40), the median QuickDASH score was 11.4 (IQR 2.3 to 31.8), and the median EQ-5D-5L score was 0.84 (IQR 0.69 to 1). The NPS was 69. Multivariate regression analysis showed that the presence of an associated ulnar styloid fracture was the only significant independent factor associated with a worse PRWE score when adjusting for confounding variables (p = 0.004). Conclusion We found that corrective osteotomy for malunion of the distal radius can result in good functional outcomes and high levels of patient satisfaction. However, the presence of an ulnar styloid fracture may adversely affect function. Level of Evidence: III (cohort study). Cite this article: Bone Joint J 2020;102-B(11):1542–1548.