Search

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.

The triangular fibrocartilage complex (TFCC) is the major stabilizer of the distal radioulnar joint. TFCC disorders may have traumatic or degenerative etiology. TFCC is most often lacerated at its ulnar periphery. According to the magnitude and direction of the traumatic force, the TFCC may rupture in a variable manner, and the ulnar styloid may also fracture, producing different subtypes of type 1B tears. Treatment options are variable, depending on the tear’s features. Atzei introduced in 2011 a novel treatment-oriented classification subdividing 1B-type lesions into five different classes according to the finding of special radiocarpal arthroscopic tests and distal radioulnar joint arthroscopy. In this chapter, the all-inside arthroscopic repair technique for Atzei class 2 and 3 TFCC foveal lesions is described.

Understanding of the exact topography of the distal radioulnar ligaments insertions remains limited. An anatomical study was performed in 21 fresh frozen cadaveric wrists, where the superficial and deep ligaments were sequentially transected sharply at their ulnar insertions. The relationships between the distal radioulnar ligament footprints relative to the bony landmarks of the ulnar styloid were digitized. Our study demonstrated that in the coronal plane, the superficial distal radioulnar ligaments inserted at an average of 87% of the styloid height proximally to the styloid tip distally. The deep distal radioulnar ligaments inserted at an average of 81% of the styloid height distally to the fovea proximally. The superficial footprint had an area of 10.6 mm2on the ulnar styloid. The deep distal radioulnar ligaments attachment was asymmetric and generally had two separate footprints. This study adds important topographical knowledge about the footprint of the distal radioulnar ligaments and may contribute to understanding the consequences of ulnar styloid fractures and distal radioulnar ligaments lesions.

Background Limited reference is available regarding surgical management in symptomatic ulnar styloid fractures with small bony avulsion. The study goal is to report the surgical outcomes using anchor suture fixation with comparison to traditional tension band wire fixation. Methods We retrospectively reviewed the medical records in patients who underwent surgical repair for unilateral ulnar styloid fractures with distal radioulnar instability between 2004 and 2017. A total of 31 patients were enrolled including two kinds of fixation methods. Anchor suture fixation plus distal radioulnar joint pinning was performed in ten patients with tiny avulsion bony fragments (group A); tension band wire fixation was performed in 21 patients with big styloid fracture fragments (group B). Patient characteristics and 2-year treatment outcomes were compared between two groups based on Mayo Modified Wrist Score (MMWS); Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH); visual analog scale (VAS), and surgical complication. Descriptive statistics were used for calculation of key variables; a p value of < 0.05 was considered statistically significant. Results Based on Gaulke classification, there were five subtypes in group A and three subtypes in group B. Incidence of concomitant distal radius fractures was significantly higher in group B; other patient characteristics including age, sex, injury side, and time to surgery showed no significant difference. Outcome assessment regarding MMWS, QuickDASH, and VAS was comparable between two groups. Bone-related complications including nonunion, DRUJ subluxation, and styloid resorption were analyzed; the difference was not significant. Incidence of implant-related complications including migration and secondary removal surgery was significantly higher in group B (p = 0.021). Conclusion Surgical fixation in symptomatic ulnar styloid fractures yields comparable treatment outcomes in both fracture patterns. Implant-related complication with secondary removal surgery is more common in tension band wire group. Anchor suture fixation is a feasible option for tiny styloid avulsion fragments with limited surgical complication.

Case A 42-year-old man presented with distal radius fracture. We performed external fixation combined with Kirschner wiring, which was removed 6 weeks postoperatively. After the removal of the implants, the patient could not achieve any pronation-supination, and distal radioulnar synostosis became apparent during the follow-up. The patient underwent distal ulnar osteotomy, and 60° pronation and full supination were achieved. No complications were reported at the 32-month follow-up. Conclusion This is a rare case of radioulnar synostosis after percutaneous fixation surgery for distal radius fracture. The modified Sauve-Kapandji procedure can help restore motion, together with other appropriate postoperative interventions, and provides early mobilization.

Objectives/Interrogation: To compare functional outcome after fixation and conservative management of basal fractures of the ulnar styloid after volar plating of distal radius fractures without DRUJ instability. Methods: This is a prospective randomized control trial conducted at an academic[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

Objectives/Interrogation: Ulnar styloid fracture is very frequently associated with distal radius fractures. Nonetheless, its clinical impact and specially its treatment are still highly debatable. The main goal of this study is evaluating the clinical outcomes of patients submitted to volar plate[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

BACKGROUND: There is a controversy regarding whether ulnar styloid fractures affect the efficacy of treatment of distal radial fractures. The purpose of this study was to investigate whether ulnar styloid fractures impact wrist joint function in patients without distal radioulnar joint instability, after distal radial fracture fixation using a volar plate. MATERIALS AND METHODS: Seventy-five patients with a distal radial fracture were treated using a volar plate between February 2010 and February 2016 (33 men and 42 women; mean age 40.9 ± 9.4 years). Forty-four patients had ulnar styloid fractures (Group A) and 31 patients did not (Group B). There were no differences between the two groups with regard to sex, age, course of the disease and fracture type (P > 0.05). RESULTS: The mean follow-up time was 21 months. There were no differences between the groups in palmar tilt, radial inclination and radial length when the distal radial fractures had healed (P > 0.05). At the final follow-up visit, the two groups were similar in terms of wrist motion range, and grip and pinch strength (P > 0.05). The Gartland–Werley scores were 13 for excellent, 26 for good, 3 for fair and 2 for poor (excellence rate 89%) for Group A, and 10 for excellent, 17 for good, 2 for fair and 2 for poor (excellence rate 87%) for Group B. The difference between the two groups was not significant (Z = − 0.097, P = 0.922). CONCLUSION: After open reduction and plate fixation of distal radial fractures, if stability of the distal radioulnar joint is achieved, untreated ulnar styloid fractures have no impact on wrist joint function.

Inconsistent positioning of patients and region of interest (ROI) is known to influence the precision of bone mineral density (BMD) measurements in the spine and hip. However, it is unknown whether minor shifts in the positioning of the ROI along the shaft of the radius affect the measurement of forearm BMD and its subregions. The ultradistal (UD-), mid-, one-third, and total radius BMDs of 50 consecutive clinical densitometry patients were acquired. At baseline the distal end of the ROI was placed at the tip of the ulnar styloid as usual, and then the forearm was reanalyzed 10 more times, each time shifting the ROI 1 mm proximally. No corrections for multiple comparisons were necessary since the differences that were significant were significant at p 0.001. The UD-radius BMD increased as the ROI was shifted proximally; the increase was significant when shifted even 1 mm proximally (p 0.001). These same findings held true for the mid- and total radius bone density, though the percent increase with moving proximally was significantly greater for the UD radius than for the other subregions. However, there was no significant change in the one-third radius BMD when shifted proximally 1-10 mm. Minor proximal shifts of the forearm ROI substantially affect the BMD of the UD-, mid- and total radius, while having no effect on the one-third radius BMD. Since the one-third radius is the only forearm region usually reported, minor proximal shifts of the ROI should not influence forearm BMD results significantly.

Background The role of surgical fixation of ulnar styloid fractures remains a subject of debate. The purpose of this study was to compare the surgical outcomes following early and late intervention. Methods We retrospectively reviewed 28 patients who underwent surgical repair for unilateral ulnar styloid fractures with distal radioulnar instability between 2004 and 2014. Surgical fixation was performed within 3 months of injury in 13 patients (group A) and beyond 3 months in 15 patients (group B). Patient characteristics and functional outcomes were compared between the two groups. The outcome survey consisted of QuickDASH score, grip strength, range of motion, pain score based on the visual analog scale, and surgical complications. Descriptive statistics were calculated for key variables. A p value of

Background: The impact of an unrepaired fracture of the ulnar styloid base on recuperation after inside obsession of a fracture of the distal piece of the sweep is unverifiable. We assessed a progression of patients with an inside settled fracture of the distal piece of the range to test the theory that there is no distinction in wrist movement or capacity scores between those with an untreated fracture of the ulnar styloid base and those with no ulnar fracture. Methods: Two partners of seventy-six coordinated patients, one with a fracture of the ulnar styloid base and the other with no ulnar fracture, were reflectively investigated by analyzing information assembled in a forthcoming investigation of plate-and-screw obsession of distal outspread fractures. Patients were coordinated for age, sex, AO fracture write, and damage component. The two partners were broke down for contrasts in movement, hold quality, torment, the Gartland and Werley score, the handicaps of the arm, shoulder and hand score, and the Short Form-36 score at six, twelve, and two years postoperatively. In a moment investigation, sixty-four patients with

Purpose In triangular fibrocartilage complex (TFCC) injuries, a foveal tear of the radioulnar ligament often requires surgery. Previous studies have suggested that surgeons should attach the TFCC to the center of the fovea. The TFCC and its insertion points are small structures, and few studies have reported details of the foveal insertion. This study aimed to clarify the morphology of the ulnar insertion of the TFCC and related osseous landmarks with 3-dimensional imaging. Methods This study used 26 formalin-fixed cadavers. At the ulna, the TFCC was inserted from the fovea to the middle part of the ulnar styloid. After gross observation of the TFCC, the ulnar insertion was outlined using a 1.0-mm drill. We then created 3-dimensional images of the ulna using computed tomography and marked (with software) an outline of the foveal insertion of the TFCC. We measured the area and the long and short diameters of the TFCC insertion. Results The area of the TFCC insertion was 34 mm2 and positively correlated with the height of the ulnar styloid and the area of the ulnar head. The TFCC’s highest point was 58% of the ulnar styloid height. The center of the TFCC insertion was 1.3 mm ulnar and 0.6 mm dorsal from the lowest point of the ulnar surface. Conclusions The center of the TFCC insertion was slightly ulnar of the lowest point of the ulnar surface. This study revealed the center, the area, and the osseous relation of the ulnar insertion of the TFCC. Clinical relevance When surgeons repair a TFCC foveal tear, they can find the anatomical center of the ulnar insertion efficiently and easily based on its osseous relationship.

Background: Fractures of the radial shaft with disruption of the distal radial ulnar joint (DRUJ) or Galeazzi fractures are treated with reduction of the radius followed by stability assessment of the DRUJ. In rare instances, the reduction of the DRUJ is blocked by interposed structures requiring open reduction of this joint. The purpose of this study is to review all cases of irreducible Galeazzi fracture-dislocations reported in the literature to offer guidelines in the diagnosis and management of this rare injury. Methods: A search of the MEDLINE database, OVID database, and PubMed database was employed using the terms “Galeazzi” and “fracture.” Of the 124 articles the search produced, a total of 12 articles and 17 cases of irreducible Galeazzi fracture-dislocations were found. Results: The age range was 16 to 64 years (mean = 25 years). A high-energy mechanism of injury was the root cause in all cases. More than half of the irreducible DRUJ dislocations were not identified intraoperatively. In a dorsally dislocated DRUJ, a block to reduction in most cases (92.3%) was secondary to entrapment of one or more extensor tendons including the extensor carpi ulnaris, extensor digiti minimi, and extensor digitorum communis, with the remaining cases blocked by fracture fragments. Irreducible volar dislocations due to entrapment of the ulnar head occurred in 17.6% of cases with no tendon entrapment noted. Conclusions: In the presence of a Galeazzi fracture, a reduced/stable DRUJ needs to be critically assessed as more than half of irreducible DRUJs in a Galeazzi fracture-dislocation were missed either pre- or intraoperatively.

Both ulnocarpal impaction syndrome and ulnar styloid impaction syndrome can produce ulnar wrist pain. The definition and clinical differentiation are explained. The relevant anatomy, biomechanics, causes, diagnosis, and arthroscopic treatments, as well as the surgical indications, techniques, and outcomes of these syndromes are discussed in detail.

The aim of this meta-analysis was to compare the functional outcomes of patients with a distal radius fracture with and without a concomitant fracture of the ulnar styloid process. A systematic literature search was performed to identify all studies comparing patients with a distal radius fracture with and without an ulnar styloid process fracture. The initial search revealed 511 articles, of which 12 articles with a total of 2243 patients were included; 1196 patients with and 1047 patients without an ulnar styloid process fracture. A statistically significant mean difference of 3.40 points (95% CI 1.33–5.48) in the Disability of the Arm, Shoulder, and Hand score was found in favour of patients without an ulnar styloid process fracture. This difference is less than 10 and therefore not clinically important. No significant difference was found in Patient-Rated Wrist Evaluation scores, range of motion, grip strength, visual analogue scale pain scores, ulnar-sided wrist pain and distal radio-ulnar joint instability between patients with and without an ulnar styloid process fracture after 1 year of follow-up. Moreover, no significant differences were found between ulnar styloid base and nonbase fractures. Level of evidence: I

The aim of our study was to project the borders of the flexor retinaculum (FR) onto superficial landmarks since its insufficient splitting is the most common reason for persistence of symptoms after carpal tunnel release. In 60 hands the radial and ulnar styloid processes were linked by a horizontal line and a longitudinal line was laid through the ring finger's radial side. These were intersected resulting in the reference point "A" on the forearm. As the second basing point "B", the radial margin of the ring finger at the palmar digital crease was chosen. Measurement of the FR was carried out with regard to the reference points. The proximal margin of the FR was located at 4% of the reference line A-B starting from point A and extended up to 52% of this total length. Results indicate that splitting alongside the proximal half of line A-B divides the FR completely. Clin. Anat. 30:512-516, 2017. © 2017 Wiley Periodicals, Inc.

Background: The deep portion of the distal radioulnar ligaments (DRUL) inserts on the ulnar fovea and is the most important stabilizer of the distal radioulnar joint (DRUJ). Ulnar styloid base fractures that include the ulnar fovea may cause DRUJ instability. Methods: DRUJ stability in pronosupination was evaluated in 12 fresh-frozen upper extremities (4 female) aged 52 to 68 years (mean: 58.8 years) using a custom fixture, which allowed free rotation of the radius around the fixed ulna. Optical motion capture was used to record rotation of the radius with respect to the ulna. Each specimen was subjected to 3 N m of torque in both supination and pronation under 4 conditions: intact, ulnar styloid osteotomy with disruption of the foveal insertion of the DRUL, ulnar styloid fixation, and DRUL transection. Group differences were compared using a 1-way repeated-measures analysis of variance and Tukey multiple comparison post hoc tests. Results: When compared with the intact condition, both ulnar styloid osteotomy and DRUL transection significantly increased mean pronation (by 9.40° and 15.21°, respectively) and supination (by 9.05° and 17.42°, respectively) of the forearm. Screw fixation only significantly reduced pronation compared with osteotomy (by 2.62°). Screw fixation did not significantly affect supination. Conclusions: Ulnar styloid fractures that disrupt the fovea cause instability of the DRUJ in pronation and supination under 3 N m of torque in a cadaveric model. Screw fixation of ulnar styloid base fractures achieves anatomic reduction; however, it only partially returns rotational stability acutely to the DRUJ and only during pronation.

Transstyloid perilunate fracture-dislocations of the carpus resulting from a force in an ulnar-to-radial direction are rare injuries. We present two cases of transstyloid perilunate fracture-dislocations of the carpus, one of which dislocated palmarly and was accompanied with fractures of the triquetrum and the ulnar styloid. The treatment algorisms are described and a satisfactory reduction is the goal for optimal functional recovery.

The influence of non-union on the outcome of distal radius fractures is debated. We tested the null hypothesis that there is no difference in pain, wrist function, or instability between patients with union or non-union of an ulnar styloid base fracture after operative treatment of a fracture of the distal radius. Eighteen adults with an ulnar styloid base non-union were compared to 16 patients with union of an ulnar styloid base fracture with a mean post-operative follow-up of 30 months. None of the patients had distal radioulnar joint instability, there were no significant differences in pain, complications, or function, and patients with nonunion had significantly greater grip strength. Ulnar styloid nonunion is not associated with pain, instability, or diminished function after fracture of the distal radius.

Background: With new low profile locked volar plate designs for distal radius fractures, soft tissue complications are uncommon. However, there are still patients who request to have their implants removed. In this study, we retrospectively reviewed the reasons for this. Methods: We reviewed the hospital operative records of patients who had operative fixation of wrist fractures between November 2008 and May 2009. We examined the clinical records of these patients in order to ascertain if there was a difference in patient demographics between those who eventually had their implants removed and those who had their implants retained. We also noted down the reasons for removal of implants. Results: In the period of study, 165 patients had operative fixation of their distal radius fractures, of which 44 (26.7%) had had their implants eventually removed. These patients tended to be younger (mean age of 37.1 years compared to 45.5 years in those who retained their implants). We also found a correlation between removal of implants and the presence of ulnar implants, as well as hand dominance. Reasons for implant removal were symptomatic irritation/implant prominence (15), joint stiffness requiring arthrolysis (6), infection (2), malunion (2), and patients who did not have a clinical reason (19). Conclusions: Our results suggest the involvement of other psychosocial factors, such as cultural attitudes towards the presence of implants within the body. In light of our results, we also suggest that ulnar styloid fractures be treated non-operatively.

Distal radioulnar dislocations typically occur in association with fractures of the distal radius and/or ulna. Rare isolated dislocations or subluxations are more difficult to diagnose and are initially missed in up to 50 % of cases. We present two cases of missed isolated volar rotatory dislocation of the distal radioulnar joint. Subtle, overlooked radiographic findings of abnormal radioulnar alignment and ulnar styloid projection are highlighted. The supplemental role of cross-sectional imaging is reviewed. Adequate clinical information, appropriate radiographic technique, and high index of suspicion are necessary for the accurate and timely diagnosis of this rare injury pattern.

The purpose of this prospective case series was to assess the efficacy of plate osteosynthesis using a low profile distal ulna plate for the management of persistently symptomatic non-unions of the base of the ulnar styloid. Six consecutive patients underwent resection of the non-union and plate osteosynthesis with a 2.0 mm distal ulna hook plate. Post-operative measurements of mean pain scores, QuickDASH scores, grip strength, and range of motion parameters showed significant improvements compared with the pre-operative values. No complications were reported at a mean follow-up of 25 months. The present study presents an alternative method for treating symptomatic ulnar styloid non-unions that provides stable fixation with low risk of implant removal.Level of Evidence: Therapeutic IV

Ulnar styloid impaction syndrome involves repetitive friction between an excessively long ulnar styloid and the carpus, resulting in chondromalacia, synovitis, and pain. The arthroscopic diagnosis, evaluation, and management of this syndrome are not well characterized. We present a patient with chronic wrist pain of unknown origin, culminating with arthroscopic findings demonstrating substantial loss of articular cartilage on both the lunate and triquetrum. The patient successfully underwent operative ulnar styloid excision, ultimately resolving chronic wrist pain symptomology.

Background: The aim of this study was to compare the functional and radiological outcomes of ulnar styloid fractures, with or without internal fixation, that followed distal radius fractures. Methods: Between January 2011 and June 2017, 206 distal radius fractures were operated on in our hospital. In total, 71 patients were included in the study. Thirty-five ulnar styloid fractures were fixed, and Thirty-six could not be fixed. The mean age of patients was 45 years (2064 years), and the mean follow-up time of patients was 19 months (1230 months) Results: In the unfixed ulnar styloid fracture group, the QuickDASH score was 20.8 and Mayo wrist score was 65. On the other hand, in the fixed ulnar styloid fracture group, the Quick DASH score was 11 and Mayo wrist score was 75. When comparing the groups, no statistically significant differences were found between their Quick DASH scores, Mayo wrist scores, grip strength, and wrist movements (p>0.05). In the unfixed group, 10 nonunions were observed, while in the fixed group, 9 nonunions were observed. Conclusion: In our study, ulnar styloid fracture fixation did not affect the functional outcomes of distal radius fractures. Surgeons should be more selective for ulnar styloid fixation in patients with ulna styloid fracture combined wrist fractures. [Hand Microsurg 2020; 9(1.000): 13-19]

The dorsal cutaneous branch of the ulnar nerve can be easily injured during surgery at the ulnar side of the wrist. We sought to identify the surgical anatomy, the pathway around the ulnar styloid process and the safe zone of the dorsal cutaneous branch of the ulnar nerve. In 44 forearm dissections, we found that the dorsal cutaneous branch of the ulnar nerve originated at a median distance of 6.8 cm proximal to the tip of the ulnar styloid. We classified the crossing pattern of the dorsal cutaneous branch of the ulnar nerve at a vertical axis into three types. The most common type featured the dorsal cutaneous branch of the ulnar nerve crossing the vertical axis at a median distance of 10.0 mm distal to the tip of the ulnar styloid. In 14% of specimens, the dorsal cutaneous branch of the ulnar nerve crossed the vertical axis at the level of the tip of the ulnar styloid. By mapping the course of the nerve using a Cartesian coordinate system, it was found that the areas located proximal and palmar to the tip of the ulnar styloid had a very high density of dorsal cutaneous branches of the ulnar nerve. We were unable to establish a safe zone. We recommend identifying the dorsal cutaneous branch of the ulnar nerve in every patient undergoing surgery at the ulnar side of the wrist.

Descripción de los hallazgos radiológicos en pacientes con fractura de radio distal tratados quirúrgicamente en la unidad de servicio de salud Red Sur Occidente Kennedy durante febrero a junio de 2018. La fractura de radio distal es una fractura común en el servicio de urgencias al que se enfrentan los ortopedistas en su ejercicio profesional, este tipo de fractura se asocia de forma frecuente a la fractura de estiloides cubital. Existe una verdadera controversia respecto a las indicaciones para la fijación de la estiloides cubital ya que no existe una clara correlación entre los efectos clínicos del manejo quirúrgico vs. conservador de la fractura de estiloides cubital. En el Servicio de Salud Red Sur Occidente Kennedy en un periodo de seis meses se recolectó una muestra de 40 pacientes con fractura de radio distal e indicación de manejo quirúrgico, con una edad media de 53 años (RIQ: 26-66 años). De estos pacientes el 72,5% presentó de forma asociada fractura de estiloides cubital, y solo el 27,6% requirió fijación de la misma y el 72, 4% recibió manejo conservador. La fractura de la base de la estiloides cubital, según la clasificación de Fernández tipo II corresponde a una factor de riesgo para inestabilidad radio-cubital distal, y tiene como resultados pobres consecuencias clínicas ya que esta sirve como lugar de inserción para el fibrocartílago triangular, por lo cual la evidencia soporta la fijación de la estiloides cubital en pacientes con fractura de la misma e inestabilidad radio-cubital distal asociada (Hideyoshi), sin embargo algunos estudios también indican que la no reparación de la fractura de estiloides cubital no afecta la función del puño cuando la fractura de radio distal es fijada mediante una placa de radio distal volar bloqueada (Zenke). En Colombia no existe un estudio comparativo de resultados clínicos entre la fijación y el manejo conservador de las fracturas de estiloides cubital, se desconoce la incidencia de este tipo de fractura, su tratamiento y su asociación con la inestabilidad radio-cubital distal por lo cual decidimos realizar este estudio. Estos datos de caracterización de nuestra población, la incidencia de fracturas de estiloides cubital asociadas a fracturas de radio distal, y el registro de las mismas según la Clasificación de Fernández para Fracturas de Estiloides Cubital es una herramienta para establecer un protocolo de su tratamiento ya sea conservador o quirúrgico. Se recomienda se debe brindar tratamiento no quirúrgico a las fracturas de las estiloides cubital si la articulación radio-cubital distal y la fractura de la estiloides son estables y el movimiento de pronosupinación se encuentra conservado. Las fracturas de la estiloides cubital que se deben tratar de manera quirúrgica si hay inestabilidad de la fractura a pesar de mantener la fractura del radio adecuadamente reducido, fracturas con desplazamiento mayor a 3mm y en casos donde el control imagenológico evidencia ensanchamiento radio-cubital distal. Description of the radiological findings in patients with distal radius fracture treated surgically in the South Western Kennedy Health Service during February to June 2018. The fracture of the distal radius is a common fracture in the emergency service faced by orthopedists in their professional practice, this type of fracture is frequently associated with ulnar styloid fracture. There is a real controversy regarding the indications for the fixation of the ulnar styloid since there is no clear correlation between the clinical effects of surgical management vs. conservative ulnar styloid fracture. At the South Western Kennedy Health Service, a sample of 40 patients with a distal radius fracture and indication of surgical management was collected over a period of six months, with a mean age of 53 years (RIQ: 26-66 years). Of these patients, 72.5% had associated ulnar styloid fractures, and only 27.6% required fixation of the same and 72.4% received conservative management. The fracture of the ulnar styloid base, according to the Fernández type II classification, corresponds to a risk factor for distal radio-ulnar instability, and results in poor clinical consequences since it serves as an insertion site for the triangular fibrocartilage, therefore, the evidence supports the fixation of the ulnar styloid in patients with fracture of the same and associated distal radio-ulnar instability (Hideyoshi), however some studies also indicate that the non-repair of the ulnar styloid fracture does not affect the function of the fist when the fracture of the distal radius is fixed by distal radius blocked plate. In Colombia there is no comparative study of clinical outcomes between fixation and conservative management of ulnar styloid fractures, the incidence of this type of fracture, its treatment and its association with distal radio-ulnar instability is not known, which is why we decided perform this study. These data of characterization of our population, the incidence of ulnar styloid fractures associated with fractures of distal radius, and the registration of them according to the Fernández Classification for ulnar styloid Fractures is a tool to establish a protocol of their treatment, either conservative or surgical. It is recommended that non-surgical treatment be given to ulnar styloid fractures if the distal radio-ulnar joint and the styloid fracture are stable and the pronosupination movement is preserved. Fractures of the ulnar styloid that should be treated surgically if there is instability of the fracture despite keeping the fracture of the radius adequately reduced, fractures with displacement greater than 3mm and in cases where the imaging control demonstrates distal radio-ulnar widening.

Distal ulnar fractures often occur with distal radius fractures (DRFs), and ulnar styloid fractures commonly occur in the setting of DRF. However, isolated ulnar head fractures are rare. We report a case of isolated ulnar head fracture in which we performed bone resection because the ulnar head bone fragment fractured when internal screw fixation was attempted. His outcome at 18 months postoperatively was considered excellent. However, we do not advocate bone resection other than failure of fixation and the difficult case to perform internal fixation. Longer follow-up would be needed because bone resection might lead to osteoarthritis of the distal radioulnar joint in the future.

In general, wrist taping is performed using a rigid tape. The present study aimed to examine the effect on grip strength exertion due to different taping pressures on the wrist joint using rigid tape. Subjects were 25 male university students (mean age, 20.2 ± 0.8 years) with over 5 years of athletic experience. The wrists of the subjects were taped using one piece of rigid tape wound three times around the wrist joint, including the radial and ulnar styloid processes. Furthermore, taping pressure was adjusted by the pressure measuring system AMI3037-SB, and the sensor was set on the palmaris longus muscle tendon of the dominant wrist. Independent variables included four taping pressure conditions (5, 30, 60, and 90 hPa) and a control (no tape) condition. Statistical analysis showed that grip strength exertion was significantly lower in the 90 hPa condition than in the control condition, but the difference was small (effect size = 0.26). In conclusion, wrist taping pressure conditions lower than 60 hPa had little effect on grip strength exertion. However, pressure conditions of 90 hPa slightly decreased grip strength and may interrupt blood flow.

Background Hematoma blocks of the radius can provide excellent analgesia for simple distal radius fractures. However, the landmark-based approach can be difficult, and ultrasound guidance may improve success of the block and analgesia during reduction. There is limited literature describing the ultrasound-guided approach, and prior case descriptions have not involved comminuted fractures or concomitant ulnar styloid fractures. Objectives This report reviews the technique of the ultrasound-guided hematoma block for distal radius fractures and introduces a second step, which can be used in the case of concomitant distal ulna fractures. Discussion The use of the ultrasound-guided hematoma block allows for direct visualization of needle advancement, as well as a simple approach to anesthetizing most distal radial and ulnar fractures. Conclusion The ultrasound-guided hematoma block may be helpful in improving anesthesia of complicated distal radial and ulnar fractures, especially when landmark-based localization is difficult.

Background Degenerative tendinopathy of the extensor carpi ulnaris (ECU) produced by the tip of an oversized ulnar styloid has not been formerly reported. Case Description We report an uncommon case of an injury to the ECU tendon that was related to a prominent oversized ulnar styloid. The patient's symptoms improved following resection of the styloid process. Literature Review Our case differs from previous reports in that it involves an uninjured oversized ulnar styloid that damaged the overlying ECU tendon with no apparent instability. Clinical Relevance Besides ulnar styloid impaction syndrome, the diagnosis of ECU tenosynovitis should also be considered in patients with ulnar-side pain and an oversized ulnar styloid.