van Rossenberg L X, Beeres F J P, van Heijl M, Hug U, Groenwold R H H, Houwert R M, van de Wall B J M
Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland.
The Diakonessenhuis Hospital Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
Eur J Trauma Emerg Surg. 2024 Dec;50(6):2843-2854. doi: 10.1007/s00068-024-02660-2. Epub 2024 Sep 13.
Ulnar styloid process (USP) fractures are present in 40-65% of all distal radius fractures (DRFs). USP base fractures can be associated with distal radioulnar joint (DRUJ) instability and ulnar sided wrist pain and are treated by conservative management and surgical fixation, without consensus. This systematic review and meta-analysis compares operative to non-operative treatment of concomitant ulnar styloid base fractures in patients with distal radius fractures.
PubMed/Medline/Embase/CENTRAL databases were searched identifying RCTs and comparative observational studies. Effect estimates were extracted and pooled using random effect models to account for heterogeneity across studies. Results were presented as (standardized) mean differences (SMD or MD) or odds ratios (OR) and corresponding 95% confidence intervals (95%CI).
Two RCTs (161 patients) and three observational studies (175 patients) were included. Tension band wiring was used for surgically treated USP fractures. Results were comparable across the different study designs and hence pooled across studies. Non-surgically treated patients had better wrist function at 6 months (SMD 0.57, 95%CI 0.30; 0.90, I = 0%). After 12 months there was no observed difference (MD 2.31, 95%CI -2.57; 7.19, I = 91%). Fewer patients had USP non-unions in the operative group (OR 0.08, 95%CI 0.04; 0.18, I = 0%). More patients suffered complications in the operative group (OR 14.3; 95%CI 1.08; 188, I = 89%).
Routinely fixating USP base fractures as standard of care is not indicated. Surgery may be considered in selective cases (e.g. persistent DRUJ instability during ballottement test after fixation of the radius).
尺骨茎突（USP）骨折在所有桡骨远端骨折（DRF）中占40%-65%。尺骨茎突基底部骨折可能与下尺桡关节（DRUJ）不稳定及尺侧腕部疼痛相关，其治疗方式包括保守治疗和手术固定，但尚无共识。本系统评价和荟萃分析比较了桡骨远端骨折患者合并尺骨茎突基底部骨折时手术治疗与非手术治疗的效果。
检索PubMed/Medline/Embase/CENTRAL数据库，以识别随机对照试验（RCT）和比较性观察性研究。提取效应估计值并使用随机效应模型进行汇总，以考虑各研究间的异质性。结果以（标准化）均值差（SMD或MD）或比值比（OR）及相应的95%置信区间（95%CI）表示。
纳入两项RCT（161例患者）和三项观察性研究（175例患者）。手术治疗的尺骨茎突骨折采用张力带钢丝固定。不同研究设计的结果具有可比性，因此在各研究间进行了汇总。非手术治疗的患者在6个月时腕关节功能更好（SMD 0.57，95%CI 0.30；0.90，I²=0%）。12个月后未观察到差异（MD 2.31，95%CI -2.57；7.19，I²=91%）。手术组尺骨茎突不愈合的患者较少（OR 0.08，95%CI 0.04；0.18, I²=0%）。手术组更多患者出现并发症（OR 14.3；95%CI 1.08；188，I²=89%）。
不建议将常规固定尺骨茎突基底部骨折作为标准治疗方法。在选择性病例中（例如桡骨固定后，在球囊试验中持续存在下尺桡关节不稳定）可考虑手术治疗。
