Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Hand (N Y). 2021 May;16(3):332-337. doi: 10.1177/1558944719855445. Epub 2019 Jul 9.
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. 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. 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, = .47) or the PRWE total score (4.8 vs 7.5, = .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, = .112; PRWE 14.8 vs 5.4, = .185). 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.
尺骨茎突骨折（USF）是与桡骨远端骨折（DRF）相关的常见伴随损伤。最近的研究发现，这些骨折是否治疗对疼痛和功能结果的影响存在相互矛盾的证据。本研究的目的是前瞻性评估连续未治疗的 USF 在手术修复的 DRF 中的疼痛和功能结果。研究假设是，如果不治疗 USF，无论是否存在 USF，结果都没有差异。
在一家机构进行了一项前瞻性研究，连续接受掌侧锁定钢板治疗的 DRF。如果存在 USF，则不进行任何治疗。未排除任何经治疗的 USF。排除了伴有尺骨颈和骨干骨折的患者。使用快速上肢功能障碍问卷（Quick Disabilities of the Arm, Shoulder, and Hand score，QDASH）和腕关节患者评估（Patient-Rated Wrist Evaluation，PRWE）评分分析功能结果测量。术后 3 个月和 1 年收集结果测量值。
手术治疗的 DRF 中 USF 的发生率为 52.2%（n=70/134）。按位置计算，尺骨茎突尖端骨折占 52.9%（n=37/70），尺骨茎突基底骨折占 46.1%（n=33/70）。在 1 年随访时，仍有 75.7%（n=53/70）的 USF 未愈合。在比较 12 个月时无 USF 的 DRF 患者与伴发 USF 的 DRF 患者时，QDASH 评分（6.7 比 8.4，=.47）或 PRWE 总分（4.8 比 7.5，=.24）无统计学差异。同样，亚组分析显示，在最终随访时，联合 USF 与非联合 USF 患者的 QDASH 或 PRWE 评分无统计学差异（QDASH 14.2 比 6.8，=.112；PRWE 14.8 比 5.4，=.185）。
USF 是一种常见的伴随损伤，在近一半接受手术治疗的 DRF 中发生。我们的前瞻性队列分析表明，在术后 1 年时，伴随 USF 的存在、类型或骨愈合状态均对患者结局或再次手术无显著影响。我们的研究证实了我们的假设，即尺骨茎突尖端和基底的 USF 应不予治疗。
