Early and late fixation of ulnar styloid base fractures yields different outcomes
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RESEARCH ARTICLE
Open Access
Early and late fixation of ulnar styloid base fractures yields different outcomes Alvin Chao-Yu Chen* , Chih-Hao Chiu, Chun-Jui Weng, Shih-Sheng Chang and Chun-Ying Cheng
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 < 0.01 was considered statistically significant. Results: Patient characteristics including age, sex, injured side, dominant side injury, and concomitant distal radius fracture showed no significant differences between the two groups. Time to surgery averaged 1.1 months in group A and 12.3 months in group B. Significantly better outcomes were found in group A than in group B, including QuickDASH scores (4.4 ± 5.9 vs. 12.9 ± 9.9) and grip strength (37.4 ± 5.1 vs. 29.1 ± 5.9 kg). Significantly better range of motion was found in group A than in group B with respect to supination (81.9° ± 4.3° vs. 75° ± 8.5°), extension (84.6 ± 4.3 vs. 76.7 ± 6.5), and flexion (80.4° ± 3.8° vs. 72° ± 4.1°). The difference was not significant in case of pronation (78.8° ± 3° vs. 74.3° ± 5.9°) and with respect to pain scores (0.6 ± 0.7 vs. 1.3 ± 1). Conclusion: Both osseous and soft tissue lesions need to be fully addressed in ulnar styloid fractures. Early detection and surgical repair yielded better outcomes. Higher complication rates in late-treated fractures show that surgeons should select surgical candidates and modalities properly. Keywords: Ulnar styloid, Distal radioulnar joint (DRUJ), Triangular fibrocartilage complex (TFCC), Distal radius fracture (DRF)
Background An ulnar styloid fracture is common and may be associated with a distal radial fracture (DRF) or occurs as an isolated injury [1]. In spite of acting as a unique strut on the ulnar end to stabilize the ulnar soft tissue and maintain the congruency of the distal radioulnar joint (DRUJ), the majority of these connected tissues including the triangular fibrocartilage complex (TFCC) are at the base of the ulnar styloid or fovea [2–4]. These tissue attachments generally allow two morphologically and functionally different fracture types with ulnar styloid injury. One type is a fracture of the ulnar styloid tip, in * Correspondence: [email protected] Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital–Linkou and Cha
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