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Introduction: Current literature reports varied significance of ulnar styloid fractures (USF) associated with distal radius fractures. Our study assesses the role of ulnar styloid fractures and fragment size in surgically managed distal radius fractures. Materials and methods: We reviewed patients who underwent surgical fixation of distal radius fractures between January 2004 to June 2006. Patients were divided into those with (Group 1) and without (Group 0) USFs. Post-operative radiographic parameters, clinical outcomes and overall wrist function were analysed. Outcomes included ulnar-sided wrist pain, extensor carpi ulnaris (ECU) tendinitis, triangular fibrocartilage complex (TFCC) grind test, distal radioulnar joint (DRUJ) instability and pain. Overall wrist function was assessed with range of motion and Disabilities of the Arm, Shoulder and Hand (DASH) score. Results: Our study cohort included 31 males and 23 females, and 38.9% of these patients had concomitant USFs. There was no difference in terms of demographic data and fracture configuration between groups. Radiographic parameters were similar, except for palmar tilt, which was significantly higher in Group 1 (4.6o vs 9.4o, p=0.047). At 24 months, there were no differences in clinical outcomes and overall wrist function. A sub-group analysis showed that mean USF fragment size was larger in patients with a positive TFCC grind test (3.9mm vs 7.3mm, p=0.033). Conclusion: The presence of USFs in surgically managed distal radius fractures does not compromise clinical and functional outcome. Similarly, the size of USFs does not impact clinical and functional outcome but is associated with the presence of a positive TFCC grind test.

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 [ABSTRACT FROM AUTHOR]

To describe a surgical approach for open repair of the triangular fibrocartilage complex foveal avulsion via ulnar styloid osteotomy, and to assess its clinical results. We reviewed 12 patients with distal radioulnar joint (DRUJ) instability due to isolated foveal avulsion of DRUJ ligaments. Wrist arthroscopy was conducted for all patients to exclude the presence of concomitant tear of the superficial part of the triangular fibrocartilage complex and to corroborate the diagnosis with a positive hook test. Through an ulnar approach between flexor and extensor carpi ulnaris, an ulnar styloid osteotomy was performed under image intensifier control just ulnar to the fovea of the head of the ulna. The avulsed foveal attachment was anchored through transosseous sutures passing from the fovea to the neck of the ulna. The ulnar styloid was fixed by means of screws or tension band wires. Outcome measures included clinical assessment of pain (visual analog scale), grip strength, DRUJ instability, range of motion of the wrist, and modified Mayo wrist score. Radiographic assessment was done to determine union of the ulnar styloid osteotomy, DRUJ subluxation, and any hardware-related problems. Outcome measures were evaluated after a mean follow-up of 21 months. Healing of the osteotomy was obtained in all cases by 11 weeks. The DRUJ laxity, visual analog scale, and modified Mayo wrist score improved, while grip strength and range of motion remained unchanged. One patient had prominent hardware necessitating removal after union of the osteotomy. There were no reported cases of injury or neuropraxia of the dorsal cutaneous branch of the ulnar nerve. Open repair of an avulsed foveal attachment of the triangular fibrocartilage complex using an ulnar styloid osteotomy is an alternative to either open or arthroscopic repair approaches. Therapeutic IV. [ABSTRACT FROM AUTHOR]

Abstract 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.

The aim was to assess the direction of distal radius fractures and their relationship to the ulnar head. We reviewed the 160 wrist radiographs. The fracture line was measured on the postero-anterior and lateral radiographs relative to the long axis of the forearm and the relationship to the ulnar head. PA radiographs: the fracture line ran distal ulnar to proximal radial (ulnar to radial) in 11%, transverse in 74% and distal radial to proximal ulnar (radial to ulnar) in 16%. Lateral radiographs: the fracture line ran distal volar to proximal dorsal in 88%, transverse in two 1% and dorsal to volar in 11%. Radial shift (7.5%) only occurred with ulnar to radial or transverse fractures. The ulnar to radial fracture line started at the proximal end of the ulnar head/distal radio-ulnar joint in 88%. The radial to ulnar fracture line started ended a mean of 2.5 mm proximal to the distal radio-ulnar joint (p < 0.01). The transverse fracture line started at the base of the distal radio-ulnar joint in 53% and proximally in 47%. There are two distinct coronal patterns: radial to ulnar ending c. 2 mm proximal to the distal radio-ulnar joint; ulnar to radial starting at the proximal distal radio-ulnar joint. There may be third pattern - transverse fractures; these may be variants of the above. Sagittally the main direction is volar to dorsal but 11% are obverse. This is the first description of distinct fracture patterns in extra-articular distal radius fractures. In addition the fracture patterns appear to correlate with different directions of force transmission which fit with our understanding of falling and the relatively uncontrolled impact of the wrist/hand with the ground. These patterns of fracture propagation help understand how the biomechanics of wrist fractures and may enable prediction of collapse. • The directions of extra-articular distal radius fractures can be identified on radiographs. • There are two distinct coronal patterns: distal radial to proximal ulnar; and distal ulnar to proximal radial. • The different coronal fracture patterns start/end at different places relative to the ulnar head. • There are two main sagittal patterns: distal volar to proximal dorsal and distal dorsal to proximal volar. • The fracture patterns appear unrelated to the presence of an ulnar styloid fracture. [ABSTRACT FROM AUTHOR]

Background: Ulnar styloid fractures (USFs) are common concomitant injuries associated with distal radius fractures (DRFs). Recent studies have found conflicting evidence on whether these fractures treated or untreated effect pain and functional outcomes. The purpose of this study was to prospectively evaluate pain and function outcomes of consecutively untreated USFs in surgically repaired DRFs. The study hypothesis was that there would be no difference in outcomes whether an USF is present or not, with all cases left untreated. Methods: A prospective study at a single institution of consecutive DRF treated surgically with volar locked plating was undertaken. No patients underwent fixation of an USF if present. There were no treated USF that were excluded. Patients with associated ulnar neck and shaft fractures were excluded. Functional outcome measures were analyzed using the Quick Disabilities of the Arm, Shoulder, and Hand score (QDASH) and the Patient-Rated Wrist Evaluation (PRWE) scores. Outcome measures were collected at 3 months and 1 year postoperatively. Results: There was an incidence of 52.2% (n = 70/134) USF associated with surgically treated DRF. By location, there were 52.9% (n = 37/70) ulnar styloid tip fractures and 46.1% (33/70) ulnar styloid base. There were 75.7% of USF (53/70) still not healed by 1-year follow-up. When comparing patients with a DRF without an USF versus DRF with an associated USF at 12 months, there was no statistical difference in the QDASH score (6.7 vs 8.4, P =.47) or the PRWE total score (4.8 vs 7.5, P =.24). Similarly, subgroup analysis showed no statistical difference in QDASH or PRWE scores at final follow-up in united USF versus nonunited USF subjects (QDASH 14.2 vs 6.8, P =.112; PRWE 14.8 vs 5.4, P =.185). Conclusions: USFs are a common concomitant injury occurring in nearly half of DRFs treated surgically. Our prospective cohort analysis showed that neither the presence, type, nor bony union status of a concomitant USF has any significant effect on patient outcomes or reoperations at 1-year postoperatively. Our study confirms our hypothesis that USF of the tip and base should be left untreated. [ABSTRACT FROM AUTHOR]

Abstract 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: Distal radius fractures are often accompanied by a fracture of the ulnar styloid process in clinical practice. For distal radius fractures with surgical indication, open reduction and internal fixation are generally performed. Treatment of ulnar styloid fracture has been controversial. OBJECTIVE: To observe the effect of ulnar styloid fracture healing on the recovery of wrist joint function after internal fixation of distal radius fracture. METHODS: Thirty-nine patients with distal radius fracture combined with ulnar styloid fracture in the Second Affiliated Hospital of Anhui Medical University from June 2016 to January 2019 were enrolled. There were 24 males and 15 females with the age from 23 to 67 years old. All patients were treated with distal radius locking plate fixation. The results of the follow-up review on anteroposterior radiograph were used to determine the healing of the distal radius fractures. According to the healing status of ulnar styloid at the last follow-up, the patients were divided into healing group (n=20) and non-healing group (n=19). The palmar tilt, ulnar inclination and radial height were compared between the two groups based on anteroposterior radiograph and that were compared to the healthy side. The wrist flexion and extension activities, forearm rotation range, and Gartlant-Werley wrist function scores were detected. The study was approved by the Ethics Committee of the Second Affiliated Hospital of Anhui Medical University. RESULTS AND CONCLUSION: (1) There was one case of ulnar-sided wrist pain in the healing group and two cases in the non-healing group; the difference was not statistically significant between the two groups (P > 0.05). There was no significant difference in fracture healing time between the two groups (P > 0.05). (2) At the last follow-up, palmar tilt and ulnar inclination of the healing group and the non-healing group were smaller than that of the healthy side (P < 0.05). However, there was no significant difference in radial height between the healthy side and the affected side (P > 0.05). There was no significant difference in the above indicators between the two groups (P > 0.05). (3) At the last follow-up, the flexion and extension range of the wrist joint in the healing group and the non-healing group were smaller than that on the healthy side (P < 0.05). There was no significant difference in the forearm rotation range between the healthy side and the affected side (P > 0.05). There was no significant difference in the above indicators between the two groups (P > 0.05). (4) At the last follow-up, there was no significant difference in the Gartlant-Werley wrist function scores or the excellent and good rate between the two groups (P > 0.05). (5) The results show that the healing of ulnar styloid fracture may not affect the rehabilitation of wrist joint after distal radius fracture fixation. The ulnar styloid process fracture can only be treated conservatively. [ABSTRACT FROM AUTHOR]

BACKGROUND: Generally, the treatment of distal radius fractures or joint dislocations is generally valued in clinical practice, but little attention is paid to the ulnar styloid fracture, and whether the ulnar styloid fracture needs to be fixed is controversial. In the study of orthopedic biomechanics, the selection of cadaver model may encounter some problems, such as different selection criteria of cadaver model and different mechanical measurement methods. OBJECTIVE: Based on Mimics software, the finite element simulation model of type Frykman VIII fracture of the distal radius fixed by plate and screw was constructed using finite element analysis. The working condition and load were set for mechanical analysis. It is hoped to provide a reference for the choice of the repair plan of this kind of fracture. METHODS: A three-dimensional finite element model of normal wrist joint was established based on the forearm and wrist CT images of a healthy volunteer. After debugging the model, Von Mises stress of the distal radius was obtained by loading the 100 N stress in the axial direction, and the validity of the model was verified by comparing with the experimental data in the literature. Two kinds of finite element models of Frykman VIII fracture with ulnar styloid type I and type II fractures were established by using finite element software to divide the mesh, cut and mold, and the model of plate and screw fixation of distal radius was assembled. Setting load under rotating working conditions, we analyzed the changes of the stress distribution of the steel plate unit in two models, and the relative displacement of the distal radioulnar joint as well as the ulnar styloid fracture broken end. RESULTS AND CONCLUSION: (1) A three-dimensional finite element model of normal wrist joint was established and validated, and the other two models of type Frykman VIII fracture of the distal radius with ulnar styloid type I and type II fractures fixed by plate and screw were established based on this model. (2) Under the same rotating load, this study showed that the stress and stress distribution of the steel plate unit in the steel plate fixation model of Frykman VIII fracture of the distal radius combined with ulnar styloid type I fracture were smaller than those of the fracture model combined with type II fracture of styloid process of ulna; the relative displacement values of the distal radioulnar joint and the ulnar styloid fracture broken end were smaller than the latter too. (3) The three-dimensional finite element model of wrist joint constructed in this study can be used to analyze the mechanical mechanism of wrist fracture. The results of finite element analysis showed that the fracture of styloid process of ulna in Frykman VIII fracture of the distal radius would affect the stability of the distal radioulnar joint, especially in the case of ulnar styloid type II fracture, which can provide a certain clinical reference for the selection of operation scheme of such fracture. [ABSTRACT FROM AUTHOR]

Background: Operative fixation has become increasingly more common for treatment of hand fractures. The dorsal cutaneous branch of the ulnar nerve (DCBUN) is a distal sensory branch of the ulnar nerve. Iatrogenic injuries during surgery were reported in previous study. Although many authors have described the DCBUN anatomy at the wrist, our review of the literature did not reveal any reports that define the relationship between DCBUN and the fifth metacarpal bone. Objective: To investigate the anatomical relationship between the DCBUN and the fifth metacarpal bone. Materials and Methods: Thirty-one fresh cadavers were dissected. The number and distribution of DCBUN branches relative to the ulnar styloid and imaginary point of the fifth metacarpal bone were recorded. Results: In 29 specimens, the DCBUN had 2 branches while the rest had 3 branches. The mean distance from the origin of DCBUN to the ulnar-most base of the bone in dorsal view (point A) was 7.41 cm. The mean distance from the DCBUN branching point to point A was 2.83 cm. The most ulnar branch of DCBUN innervated to subcutaneous border along the most ulnar and palmar side of the bone. The mean proportion of the length between point G, where the most radial branch crosses over the most radial side of the bone and the radial-most base of the bone in dorsal view (point B) (GB), and the length of the most radial side of the bone between base (point B) and head (point D) (BD) was 0.15 (range: 0.0 to 0.45). Conclusion: The results of the present study suggest the safe area for making a skin incision to be at the mid-axial ulnar side of the fifth metacarpal bone to prevent ulnar branch injury. A dorsal skin incision over the proximal half of the fifth metacarpal bone may injure the radial branch. [ABSTRACT FROM AUTHOR]

Background: fracture of the distal radius is the most common type of fracture in the upper extremity. Because the radius plays a fundamental role in the stability of the wrist joint, preservation of ligamentous function of the wrist and the biomechanics of radiocarpal and radioulnar joints, anatomical reduction and correction of articular surface incongruity decreases the potential of degeneration and accelerates post-injury rehabilitation. Objective: the aim of this study is targeting fixation of ulnar styloid fracture associated with distal radius fracture by K wires" Tension Band" and detecting the effect of these fractures on final wrist outcome. Patients and Methods: ten cases with fracture of ulnar styloid were managed over the last year from July 2017 to march 2018. Case selection was according to: 1- Base fracture of ulnar styloid (Type 2). 2- Involvement more than 50% of the height of ulnar styloid. Results: our study showed that one patient developed non-union, one patient developed infection, two patients with injury to dorsal cutaneous branch of ulnar nerve and one patient developed DRUJ instability. According to Mayo Clinic Wrist Score; one patient achieved excellent Mayo Score, two with good score, five with satisfactory score and two with poor score. Conclusion: although Open reduction and internal fixation is recommended in case of base fracture if there is displacement more than 2mm or if there is associated DRUJ instability as it is associated with high union rate and less rate of DRUJ instability. [ABSTRACT FROM AUTHOR]

The purpose of this study was to systematically quantify distal radioulnar joint stability with a cadaveric model, using radiographic and joint contact force measurements. Six fresh-frozen cadavers underwent sequential ulnar styloid osteotomies. Posteroanterior and lateral stress radiographs were obtained and joint contact forces and areas were measured. Posteroanterior radiographs showed a significant increase in the distal radioulnar joint gap after osteotomy of the base of the ulnar styloid. Contact force and contact area measurements were not significantly different. We conclude that fractures that involve the ulnar styloid base should be considered for operative fixation when carrying out open reduction and internal fixation of fractures of the distal radius. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]