Ulnar styloid fractures associated with distal radius fractures: Incidence and implications for distal radioulnar joint instability

May, Megan M.; Lawton, Jeffrey N.; Blazar, Philip E.

doi:10.1053/jhsu.2002.36525

Cited by 228 publications

(189 citation statements)

References 41 publications

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“…The factors associated with this injury, however, rarely have been studied. Because of its anatomic proximity to the triangular fibrocartilage complex, fracture of the ulnar styloid at its base has been postulated to cause DRUJ instability [12,28,33,37]. However, well-designed studies consistently denied the association between symptomatic DRUJ instability and the ulnar styloid fracture in distal radius fractures [15,35,39,44].…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiographic Factors Associated With Distal Radioulnar Joint Instability in Distal Radius Fractures

Kwon

Seo

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Distal radioulnar joint (DRUJ) instability is an important cause of ulnar-sided wrist pain in distal radius fractures. However, instability is frequently undiagnosed and the clinical and radiographic factors associated with instability are not well understood. Questions/purposes We therefore identified clinical and radiographic factors associated with DRUJ instability in distal radius fractures. Patients and Methods We retrospectively reviewed all 221 patients who underwent surgical treatment for unstable distal radius fractures from 2007 to 2010. Ten patients (five men and five women) had DRUJ instability by intraoperative manual testing (Group I); these patients had a median age of 52 years. The other 211 patients (81 men and 130 women) (Group II) had a median age of 55 years.Clinical and radiographic data were compared between the groups. ResultsThe incidence of open wounds at the wrist and the relative ulnar length measured on the prereduction radiograph were greater in Group I. An open wound at the wrist and positive ulnar variance of 6 mm or greater on the prereduction radiograph increased the risk of DRUJ instability (relative risks = 45 and 17, respectively) in distal radius fractures.

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Section: Discussionmentioning

confidence: 99%

Clinical and Radiographic Factors Associated With Distal Radioulnar Joint Instability in Distal Radius Fractures

Kwon

Seo

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…In combination with previous findings, this may explain why $58% of distal radius fractures also involve the distal ulna. 37 Resultant impact reaction forces and loading rates increased significantly between the pre-fracture and crack events, followed by a nonsignificant decrease at fracture. This was despite an increase in the impact energy, impulse, and impulse duration between crack and fracture.…”

mentioning

confidence: 93%

“…This explains why almost 60% of distal radius fractures are accompanied by some form of ulnar involvement, most commonly the ulnar styloid process. 37 The radii were tested in isolation of the ulna and surrounding soft tissues that would normally help align the bones of the radio-carpal joint and provide support to the radius. Potting the specimen up to the distal third provided some structural support, which would otherwise be taken up by the surrounding tissues.…”

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confidence: 99%

Failure characteristics of the isolated distal radius in response to dynamic impact loading

Burkhart

Andrews

Dunning

2011

Journal Orthopaedic Research

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We examined the mechanical response of the distal radius pre-fracture and at fracture under dynamic impact loads. The distal third of eight human cadaveric radii were potted and placed in a custom designed pneumatic impact system. The distal intraarticular surface of the radius rested against a model scaphoid and lunate, simulating 458 of wrist extension. The scaphoid and lunate were attached to a load cell that in turn was attached to an impact plate. Impulsive impacts were applied at increasing energy levels, in 10 J increments, until fracture occurred. Three 458 stacked strain gauge rosettes were affixed along the length of the radius quantifying the bone strains. The mean (SD) fracture energy was 45.5 (16) J. The mean (SD) resultant impact reaction force (IRFr) at failure was 2,142 (1,229) N, resulting in high compressive strains at the distal (2,718 (1,698) me) and proximal radius (3,664 (1,890) me). We successfully reproduced consistent fracture patterns in response to dynamic loads. The fracture energy and forces reported here are lower and the strains are higher than those previously reported and can likely be attributed to the controlled, incremental, dynamic nature of the applied loads. Keywords: radius; impact; fracture; forward fall; injury criteriaThe distal radius is a common fracture site, often resulting from a forward fall. Nevitt and Cummings 1 reported that, of 337 forward falls, 39% resulted in a wrist fracture, with more than 60% requiring some form of surgical intervention. 2,3 This has lead to these injuries being identified as a major health problem, 4 and the World Health Organization has listed fracture prevention among healthcare priorities. 5 Nonetheless, fracture frequency remains high ($164,000 emergency room visits/year from 1991 to 2009 in the US alone 6 ), and researchers have been unable to determine optimal treatment strategies for various patterns and severities of wrist fractures. 7 Although general consensus exists regarding risk factors for distal radius fractures, 8 prevention of these injuries requires a more thorough understanding of the injury mechanisms. The injury mechanism is one of the most important elements of the history, 7 as this information can help discern the degree of damage to the bone and the surrounding soft tissues. Beardley et al. 9 identified the importance of understanding the energy involved in a fracture as it generally determines the degree of comminution, thus affecting the treatment protocol.An accurate understanding of the injury mechanisms (e.g., kinetic energy involved and direction of loading) can be accomplished by improving our knowledge of the input parameters and the bones' response to dynamic loading through valid laboratory studies. 10 Many researchers mechanically loaded human cadaver specimens to determine the maximal strength of the distal radius, 10-22 but methodological inconsistencies have led to variability in results. Researchers studied the response to dynamic impact loads 10,[17][18][19] to better simulate real-worl...

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“…성을 강조한 문헌들이 적고 골절 유합 후 지속적인 완관절 주 위 동통 9,10 이나 불안정, 특히 회전 운동의 제한 11 비교하여 원위 요골 관절면의 장측경사 0�이상, 척측 경사도 5�이상, 관절면의 부조화 2 mm 이내, 특히 원위 요-척 관절 의 이개나 부조화가 없고, 중립위 척골 변이 및 원위 척골 경 상 돌기의 관절면 불유합 소견 등이 없는 경우를 만족스러운 정복으로 판단하였다 12,13 . 임상적으로는 도수 정복 혹은 수술 후 평균 6개월째 환자의 지난 주 일상 생활의 완관절 기능 평 가를 disabilities of the arm, shoulder and hand (DASH) score 13 , 원위 요-척 관절 주변부 통증의 정도는 visual analogue scale (VAS)를 이용하여 평가하였고, 또 완관절의 회외 전과 회내전 각도를 측정하였다 (Table 1) …”

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“…임상적으로는 도수 정복 혹은 수술 후 평균 6개월째 환자의 지난 주 일상 생활의 완관절 기능 평 가를 disabilities of the arm, shoulder and hand (DASH) score 13 , 원위 요-척 관절 주변부 통증의 정도는 visual analogue scale (VAS)를 이용하여 평가하였고, 또 완관절의 회외 전과 회내전 각도를 측정하였다 (Table 1) …”

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Treatment of Distal Radioulnar Joint Injuries Associated with a Distal Radius Fracture

Choi

Huh

Kim

et al. 2012

J Korean Soc Surg Hand

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Purpose: Distal radius fractures involving distal radioulnar joint (DRUJ) are common. After the fracture treatment, pain on the ulnar side of wrist, limitation of forearm rotation and instabilities can be remained. The purpose of this study was to address the importance of anatomical reduction for DRUJ injuries. Methods:Of 115 cases with a distal radius fracture involving DRUJ, 61 cases involving sigmoid notch of the radius or having a ulnar styloid process base fracture were evaluated. At an average of six months follow-up, their final outcomes were investigated using radiologic findings, functional disabilities of the arm, shoulder and hand (DASH) and visual analogue scale (VAS) pain scores and wrist motion of pronation/supination.Results: Satisfied radiologic reduction rate was 73.8%(45/61) in average, which was most favorable in external fixator group (82.4%, 28/34). The mean functional DASH score was 29.0 points and mean VAS for pain was 5.0. The mean range of wrist motions for pronation/supination was 59.5°/55.7°. Conclusion:Distal radius fractures involving DRUJ should be classified into the basic categories of unstable distal radius fracture, and immediate anatomical reduction is needed by operative treatment to avoid painful forearm rotation.

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Ulnar styloid fractures associated with distal radius fractures: Incidence and implications for distal radioulnar joint instability

Cited by 228 publications

References 41 publications

Clinical and Radiographic Factors Associated With Distal Radioulnar Joint Instability in Distal Radius Fractures

Clinical and Radiographic Factors Associated With Distal Radioulnar Joint Instability in Distal Radius Fractures

Failure characteristics of the isolated distal radius in response to dynamic impact loading

Treatment of Distal Radioulnar Joint Injuries Associated with a Distal Radius Fracture

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