Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, South Korea.
Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, South Korea.
Orthop Traumatol Surg Res. 2022 Sep;108(5):103322. doi: 10.1016/j.otsr.2022.103322. Epub 2022 May 13.
Nonunion of ulnar styloid fractures after radius stabilisation by volar locking plate (VLP) fixation without surgical fixation on ulnar styloid fractures is quite common. However, the factors affecting the nonunion of ulnar styloid fractures and their effect on functional outcomes in patients with distal radius fractures (DRFs) treated with VLP fixation are unclear.
The purpose of this study was to investigate the predictors affecting nonunion of unrepaired ulnar styloid fractures in patients with DRFs and the effect of nonunion and its predictors on functional outcomes.
We retrospectively reviewed data from 84 patients with DRF who underwent VLP fixation. None of the accompanying ulnar styloid fractures were manipulated during the surgery. Postoperative evaluation included the measurement of the grip strength, wrist range of motion, and Disabilities of the Arm, Shoulder, and Hand score at a minimum of one year postoperatively. Patients were divided into the nonunion and union groups according to the presence of union of ulnar styloid fracture. Demographic and radiologic parameters, including age, sex, bone mineral density, location and displacement distance of ulnar styloid fracture, and fracture pattern of DRFs, were analysed to identify predictors of nonunion. Functional outcomes were compared between the two groups and were compared according to the presence of predictors of nonunion.
Univariate analysis revealed that the nonunion rate was higher in ulnar styloid non-base fractures, substantial displacement (≥1.9mm) of ulnar styloid fracture, and AO/OTA C-type DRF. However, multivariate logistic regression analysis showed that non-base fractures and substantial displacement were significant predictors. Accompanying ulnar styloid fracture nonunion and its predictors were found not to influence functional outcomes.
Substantial displacement and non-base fracture are predictive factors for nonunion of unrepaired ulnar styloid fractures after DRF treatment with VLP fixation. However, nonunion and its predictors do not influence the overall wrist function. These findings suggest that the ulnar styloid fracture accompanying DRF should not be considered a fracture affecting the wrist function when treating with VLP fixation.
III, Retrospective, Case Control study.
桡骨掌侧锁定钢板（VLP）固定稳定桡骨后，尺骨茎突骨折未行手术固定，导致尺骨茎突骨折不愈合较为常见。然而，影响 VLP 固定治疗下桡骨远端骨折（DRF）患者尺骨茎突骨折不愈合的因素及其对患者功能结果的影响尚不清楚。
本研究旨在探讨影响 DRF 患者未修复尺骨茎突骨折不愈合的预测因素，以及骨折不愈合及其预测因素对功能结果的影响。
我们回顾性分析了 84 例接受 VLP 固定治疗的 DRF 患者的数据。手术过程中未对伴发的尺骨茎突骨折进行处理。术后评估包括术后至少 1 年的握力测量、腕关节活动范围和上肢残疾问卷（DASH）评分。根据尺骨茎突骨折是否愈合，将患者分为骨折愈合组和骨折不愈合组。分析患者的年龄、性别、骨密度、尺骨茎突骨折的位置和移位距离以及 DRF 的骨折类型等人口统计学和影像学参数，以确定骨折不愈合的预测因素。比较两组患者的功能结果，并根据骨折不愈合的预测因素进行比较。
单因素分析显示，尺骨茎突非基底部骨折、尺骨茎突骨折明显移位（≥1.9mm）和 AO/OTA C 型 DRF 的骨折不愈合率较高。然而，多因素逻辑回归分析显示，非基底部骨折和明显移位是显著的预测因素。伴发的尺骨茎突骨折不愈合及其预测因素并不影响功能结果。
尺骨茎突骨折不愈合的预测因素是明显的移位和非基底部骨折。然而，骨折不愈合及其预测因素并不影响腕关节的整体功能。这些发现表明，在 VLP 固定治疗 DRF 时，不应将伴发的尺骨茎突骨折视为影响腕关节功能的骨折。
III，回顾性病例对照研究。
