Kumar Prasoon, Dadra Ankit, Rajnish Rajesh Kumar, Sharma Siddhartha, Patel Sandeep, Dhillon Mandeep Singh, Aggarwal Sameer
Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
J Clin Orthop Trauma. 2024 Aug 22;55:102519. doi: 10.1016/j.jcot.2024.102519. eCollection 2024 Aug.
The most common upper limb fracture encountered in clinical practice is distal radius fracture (DRF). They frequently occur due to falls onto an outstretched hand or other traumatic incidents, resulting in a break in the radius near the wrist joint. DRFs often present a spectrum of injuries and are a common reason for emergency department visits, affecting approximately one out of every six patients seeking medical attention in this setting.
This systematic review was performed according to the guidelines of PRISMA, using the electronic database search of PubMed, Embase, Scopus, and Cochrane Library, and the protocol for the review was registered to PROSPERO. All comparative study designs (prospective or retrospective) that compared fixation of ulnar styloid and no fixation in a case of ipsilateral distal end radius fracture were included.
The current review analyzed 336 patients from five studies, two randomized controlled trials (RCTs), two prospective, and one retrospective comparative study. The meta-analysis revealed a significantly higher rate of union in fixation group than the no-fixation group, with an odds ratio of 10.29 (95%CI 4.74, 22.32; p < 0.00001). However, no significant differences were found in other radiological parameters such as radial inclination, volar angle, and ulnar variance. Regarding functional outcomes, the result was equivocal for the two groups regarding DASH/quick DASH score, Modified Mayo Wrist score MD of 0.22 [95 % CI -1.84, 2.28, p = 0.83; I2 = 0 %], grip strength, range of motion, and overall complications OR of 0.53 (95 % CI 0.08, 3.47; p = 0.51; I2 = 86 %), but higher occurrence of ulnar-sided pain, hardware prominence, and paraesthesias.
Fixation of ulnar styloid in conjunction with DRF does not significantly benefit patients. Despite better styloid union rates, it increases implant-related complications without improving final function, range of motion, stability, or grip strength. Patients may experience increased ulnar-sided pain due to implant prominence. Therefore, non-fixation of the ulnar styloid process is recommended as it offers no significant advantages.
临床实践中最常见的上肢骨折是桡骨远端骨折（DRF）。它们常因伸手撑地摔倒或其他外伤事件而发生，导致腕关节附近的桡骨骨折。DRF常呈现一系列损伤情况，是急诊科就诊的常见原因，在此情况下，约每六名就医患者中就有一人受其影响。
本系统评价按照PRISMA指南进行，通过电子数据库检索PubMed、Embase、Scopus和Cochrane图书馆，并将该评价方案注册到PROSPERO。纳入所有比较同侧桡骨远端骨折时尺骨茎突固定与不固定的比较研究设计（前瞻性或回顾性）。
本综述分析了五项研究中的336例患者，包括两项随机对照试验（RCT）、两项前瞻性研究和一项回顾性比较研究。荟萃分析显示，固定组的愈合率显著高于不固定组，优势比为10.29（95%CI 4.74, 22.32；p < 0.00001）。然而，在其他放射学参数如桡骨倾斜度、掌倾角和尺骨变异方面未发现显著差异。关于功能结局，两组在DASH/快速DASH评分、改良梅奥腕关节评分（MD为0.22 [95%CI -1.84, 2.28, p = 0.83；I2 = 0%]）、握力、活动范围和总体并发症（OR为0.53 [95%CI 0.08, 3.47；p = 0.51；I2 = 86%]）方面结果不明确，但尺侧疼痛、内植物突出和感觉异常的发生率较高。
桡骨远端骨折合并尺骨茎突固定对患者并无显著益处。尽管茎突愈合率更高，但它增加了与植入物相关的并发症，而未改善最终功能、活动范围、稳定性或握力。患者可能因植入物突出而出现尺侧疼痛增加。因此，建议不固定尺骨茎突，因为它没有显著优势。
