Classification and treatment of ulnar styloid nonunion

doi:10.1016/S0363-5023(96)80355-8

The Journal of Hand Surgery

Volume 21, Issue 3, May 1996, Pages 418-422

https://doi.org/10.1016/S0363-5023(96)80355-8 Get rights and content

Symptomatic nonunion of the ulnar styloid is an uncommon problem that is usually best treated by simple excision of the ulnar styloid fragment. Two types of nonunion of the ulnar styloid are described here on an anatomic basis, and their treatment differs. Type 1 is defined as a nonunion associated with a stable distal radioulnar joint. Type 2 is defined as a nonunion associated with subluxation of the distal radioulnar joint. The postoperative follow-up period for the two types ranged from 4 months to 13 years, with a mean of 5 years 2 months. Eleven type 1 wrists were treated with excision of the fragment, and all patients had satisfactory relief of pain. Nine type 2 wrists required restoration of the anatomy of the triangular fibrocartilage complex. Three of these had large fragments that were treated by open reduction and internal fixation. All three patients were completely relieved of their discomfort. Six other patients underwent excision of the fragment and repair of the triangular fibrocartilage complex to the distal ulna. This group had four excellent, one good, and one fair result. If the distal radioulnar joint is stable on presentation or if its stability is restored, then long-term relief of pain from ulnar styloid nonunion is achieved by treatment of the nonunion.

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Cited by (132)

Management of Ulnar Styloid Nonunions
2024, Hand Clinics
Headless screw fixation of unstable ulnar styloid base fractures after distal radial fractures fixation
2024, Journal of Hand and Microsurgery
Ulnar styloid fractures occur frequently concomitant with distal radial fractures. Although unstable distal radial fractures are mostly surgically treated, ulnar styloid fractures are often ignored. Unstable fractures at the base of the ulnar styloid may lead to persistent ulnar pain, due to distal radioulnar joint instability or ulnar styloid non-union.
We retrospectively analyzed a single-surgeon cohort series of surgically treated distal radial fractures on how these concomitant ulnar styloid fractures were regarded: indications for surgery and surgical technique with headless screw fixation.
119 surgically treated distal radial fractures were assessed. 51 (42.8%) of the surgically treated distal radial fractures had a distal ulnar fracture, and more specifically 23 (19.3%) had a base fracture of the ulnar styloid. 9 (7.6%) of the wrists had a base fracture of the ulnar styloid which was considered after distal radial fracture fixation as persistently unstable, during distal radioulnar joint ballottement translation test. This fracture subtype was immediately treated with headless screw fixation, resulting in all cases in bony union, with a mean active pronation of 85°, a mean active supination of 80° and a clinical stable distal radioulnar joint, with minimal ulnar pain after 6 weeks (mean Visual Analogue Scale 1). After at least 12 months, persistent pain did not occur and mean QuickDASH was 2.5.
According to this single-surgeon cohort series, headless screw fixation provides a reliable treatment for unstable base fractures of the ulnar styloid after distal radial fixation.
Should ulnar styloid be fixed following fixation of a distal radius fracture?<sup>,</sup>
2023, Injury
Fracture of the base of the ulnar styloid has shown to have higher incidence of TFCC tears and DRUJ instability leading to nonunion and impaired function. Poorer functional outcomes of the distal radius fracture have been attributed to the untreated associated ulnar styloid fractures while some studies have shown no difference. Thus, the treatment remains controversial. However, it has been shown that fractures at the base of the ulnar styloid have a higher incidence of tears in the triangular fibrocartilage complex (TFCC) and instability in the distal radioulnar joint (DRUJ), which can lead to nonunion and impaired function. Despite this, there are currently no studies comparing the outcomes of surgically and conservatively treated patients.
A retrospective study was conducted to analyze the outcomes of intra-articular distal radius fractures associated with base of ulnar fracture treated with distal radius LCP fixation. The study included 14 patients who were treated surgically and 49 patients who were treated conservatively, with a minimum follow-up of 2 years. Radiological parameters such as union and amount of displacement, VAS score for ulnar-sided wrist pain, functional assessment using the modified Mayo score and the quick DASH questionnaire and complications were analyzed.
At the final follow-up, the mean scores for pain (VAS), functional outcomes (modified Mayo score), disability (QuickDASH score), range of motion, and non-union rate were found to be statistically insignificant (p > 0.05) between the surgically treated and conservatively treated groups. However, patients with non-union had statistically significant higher scores for pain (VAS), greater post-operative displacement of the styloid, poorer functional outcomes, and higher disability (p < 0.05).
While there was no significant difference in ulnar-sided wrist pain and functional outcomes between the surgically treated and conservatively treated groups, the conservatively treated cases had a higher risk of non-union, which can negatively impact functional outcomes. The amount of pre-operative displacement was found to be a key factor in predicting non-union and can be used as a guide for determining the management of this type of fracture.
Triangular Fibrocartilage Complex Injuries in Children and Adolescents
2021, Hand Clinics
What's the best surgical repair technique of an ulnar styloid fracture? A biomechanical comparison of different techniques
2021, Injury
8-10% of all Ulnar styloid fractures (USF) accompanying distal radius fractures are addressed surgically. The surgical fixation has to counteract forces of translation and rotation acting on the distal radioulnar joint (DRUJ). The different technics used were never compared biomechanically. Our study aims to compare the effects of different techniques of USF fixation on the forearm rotation and the dorsal-palmar (DP)-translation of the DRUJ.
9 forearm specimens were mounted on a custom testing system. Load was applied for Pronosupination and DP-translation with the forearm placed in neutral position, pronation and supination. The positional change of the DRUJ was measured using a MicroScribe. Six different, sequential conditions were tested in the same specimen: intact, USF and 4 repair techniques (2 K-wire, tension band wiring (TBW), headless compression screw, suture anchor).
The USF significantly increased DP-translation and pronosupination compared to the intact condition. The DP-translation in neutral was reduced significantly with all four techniques compared to the USF condition. TBW and suture anchor also showed a significant difference to the K-wire fixation. In supination only the TBW and suture anchor significantly decreased DP-Translation. The rotational stability of the DRUJ was only restored by the K-wire fixation and the TBW.
All four USF repair techniques partially restored translational stability; however, only K-wire fixation and TBW techniques restored rotational stability. TBW was biomechanically superior to the other techniques as it restored translational stability and rotational stability.
Management of injuries to the triangular fibrocartilage complex and distal radioulnar joint
2021, Orthopaedics and Trauma
Injuries to the triangular fibrocartilage complex (TFCC) and distal radioulnar joint (DRUJ) require careful consideration and management to ensure an optimal outcome. These complex injuries can be effectively managed by having a fundamental understanding of the anatomy of the structures involved in addition to an appreciation of the biomechanical modes of failure in the context of wrist trauma. The principles of managing these injuries are addressed in this article by focusing on the relevant anatomy and highlighting the key features of clinical and radiological assessment. An outline of the surgical treatment options is included to help the clinician select the most appropriate treatment ranging from soft tissue repair to salvage measures.

View all citing articles on Scopus

^*: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

¹: From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Section of Surgical Sciences Pennsylvania State University College of Medicine, Hershey, PA, and the Department of Orthopaedic , Surgery, State University of New York Health Sciences Center, Syracuse, NY

View full text

Classification and treatment of ulnar styloid nonunion*

J Hand Surg

J Hand Surg

Arthroscopy

J Hand Surg

J Hand Surg

Hypertrophic ulnar styloid nonunions

Clin Orthop

Injuries of the articular disc at the wrist

J Bone Joint Surg

Traumatic dislocation of the distal radioulnar joint

Clin Orthop

Anterior dislocation of the head of the ulna

Ann Surg

Resection of the distal end of the ulna

J Bone Joint Surg

Traumatic disruption of the triangular fibrocartilage complex

Clin Orthop

A Darrach procedure for distal ulnar pathology derangements

Clin Orthop