Comparative study of short-term effectiveness of three surgical methods for ulnar styloid base fracture complicated with triangular fibrocartilage complex injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TIAN Yong ^1,2 , DONG Jiahe ^1,2 , WU Yilong ^1,2 , TIAN Jiangbo ² , SHANG Wanshan ² , ZHANG Hailong ² ,  WANG Xiaohui ²

1. Graduate School, Henan University of Chinese Medicine, Zhengzhou Henan, 450046, P. R. China;
2. The Second Department of Sports Medicine and Arthroscopy, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P. R. China;

Corresponding?author：

WANG Xiaohui, Email: 963099784@qq.com

Keywords：

Ulnar styloid base fracture; triangular fibrocartilage complex; arthroscopy; internal fixation; short-term effectiveness

DOI：

10.7507/1002-1892.202403043

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Objective To compare the short-term effectiveness of arthroscopic suture of triangular fibrocartilage complex (TFCC), arthroscopic suture of TFCC combined with open reduction and internal fixation, and simple open reduction and internal fixation in the treatment of distal radius fractures combined with ulnar styloid base fractures and TFCC injury. Methods A clinical data of 97 patients with distal radius fractures combined with ulnar styloid base fracture and TFCC injury, who were admitted between September 2019 and September 2022 and met the selective criteria, was retrospectively analyzed. After reduction and internal fixation of distal radius fractures, 37 cases underwent arthroscopic suture of TFCC (TFCC group), 31 cases underwent arthroscopic suture of TFCC combined with open reduction and internal fixation of ulnar styloid base fractures (combination group), and 29 cases underwent simple open reduction and internal fixation of ulnar styloid base fractures (internal fixation group). There was no significant difference in baseline data between groups (P>0.05), such as gender, age, injury side, time from injury to operation, and preoperative radius height, palm inclination, ulnar deviation, grip strength, wrist range of motion (ROM) in rotation, ulnar-radial deviation, and flexion-extension. The differences (change value) in radius height, metacarpal inclination angle, ulnar deviation angle, grip strength, and wrist ROM in rotation, ulnar-radial deviation, and flexion-extension between preoperative and 12 months after operation in 3 groups were compared. The effectiveness was evaluated according to the modified Gartland-Werley score at 12 months after operation. Results All incisions healed by first intention. All patients were followed up 12-18 months (mean, 14 months). X-ray films showed that there were 4 patients with non-union of ulnar styloid base fracture in TFCC group, and the remaining patients had fracture healing at 3 months after operation. The radius height, palm inclination, and ulnar deviation of 3 groups at 12 months after operation were significantly better than those before operation (P<0.05); however, the differences in the change values of the above indexes between groups was not significant (P>0.05). At 12 months after operation, the change values of wrist ROM in rotation, ulnar-radial deviation, and flexion-extension in the TFCC group and the combination group were significantly greater than those in the internal fixation group (P<0.05), and there was no significant difference between the TFCC group and the combination group (P>0.05). The change values of grip strength was significantly greater in the combination group than in the internal fixation group (P<0.05); there was no significant difference between the other groups (P>0.05). The excellent and good rates according to the modified Gartland-Werley score were 91.89% (34/37), 93.54% (29/31), and 72.41% (21/29) in the TFCC group, the combination group, and the internal fixation group, respectively. The excellent and good rates of the TFCC group and the combination group were significantly higher than that of the internal fixation group (P<0.05); there was no significant difference between the TFCC group and the combination group (P>0.05).Conclusion For ulnar styloid base fractures with TFCC injury, compared with simple open reduction and internal fixation, arthroscopic suture of TFCC or suture TFCC combined with internal fixation treatment are both beneficial for wrist function recovery, and their short-term effectiveness are similar. Therefore, arthroscopic suture of TFCC may be a better choice.

Citation： TIAN Yong, DONG Jiahe, WU Yilong, TIAN Jiangbo, SHANG Wanshan, ZHANG Hailong, WANG Xiaohui. Comparative study of short-term effectiveness of three surgical methods for ulnar styloid base fracture complicated with triangular fibrocartilage complex injury. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(8): 968-975. doi: 10.7507/1002-1892.202403043 Copy

1.	Velmurugesan PS, Nagashree V, Devendra A, et al. Should ulnar styloid be fixed following fixation of a distal radius fracture? Injury, 2023, 54(7): 110768. doi: 10.1016/j.injury.2023.04.055.
2.	Tomori Y, Nanno M, Takai S. The presence and the location of an ulnar styloid fracture associated with distal radius fracture predict the presence of triangular fibrocartilage complex 1B injury. Arthroscopy, 2020, 36(10): 2674-2680.
3.	張琳袁, 劉志清, 王躍挺, 等. 尺骨莖突骨折對C型橈骨遠端骨折術后療效的影響. 中華手外科雜志, 2020, 36(3): 180-184.
4.	Maniglio M, Truong V, Zumstein M, et al. Should we repair the pronator quadratus in a distal radius fracture with an ulnar styloid base fracture? A biomechanical study. J Wrist Surg, 2021, 10(5): 407-412.
5.	Lutsky KF, Lucenti L, Beredjiklian PK. Outcomes of distal ulna fractures associated with operatively treated distal radius fractures. Hand (N Y), 2020, 15(3): 418-421.
6.	葉曙明, 徐春歸, 張積森, 等. 尺骨莖突骨折是否愈合對橈骨遠端骨折術后關節功能的影響. 中國組織工程研究, 2020, 24(33): 5321-5325.
7.	Sarmiento A, Pratt GW, Berry NC, et al. Colles’ fractures. Functional bracing in supination. J Bone Joint Surg (Am), 1975, 57(3): 311-317.
8.	盧承印, 張海龍, 張來福, 等. 腕關節鏡下解剖修復Atzei-EWAS 2型三角纖維軟骨復合體損傷. 中國修復重建外科雜志, 2021, 35(11): 1417-1421.
9.	方凱彬, 王文懷. 腕關節鏡輔助治療關節內橈骨遠端骨折的早期療效觀察. 中國修復重建外科雜志, 2019, 33(2): 138-143.
10.	Daun M, Rudd A, Cheng K, et al. Magnetic resonance imaging of the triangular fibrocartilage complex. Top Magn Reson Imaging, 2020, 29(5): 237-244.
11.	Zlatkin MB, Rosner J. MR imaging of ligaments and triangular fibrocartilage complex of the wrist. Radiol Clin North Am, 2006, 44(4): 595-623.
12.	Stuart PR, Berger RA, Linscheid RL, et al. The dorsopalmar stability of the distal radioulnar joint. J Hand Surg (Am), 2000, 25(4): 689-699.
13.	Bayoumy MA, El-Sayed A, Elkady HA, et al. Arthroscopic treatment of type 1B triangular fibrocartilage complex tear by “outside-in” repair technique using transcapsular transverse mattress suture. Arthrosc Tech, 2017, 6(5): e1581-e1586.
14.	Pidgeon TS, Crisco JJ, Waryasz GR, et al. Ulnar styloid base fractures cause distal radioulnar joint instability in a cadaveric model. Hand (N Y), 2018, 13(1): 65-73.
15.	Kim KW, Lee CH, Choi JH, et al. Distal radius fracture with concomitant ulnar styloid fracture: does distal radioulnar joint stability depend on the location of the ulnar styloid fracture? Arch Orthop Trauma Surg, 2023, 143(2): 839-845.
16.	成帥, 江善勇, 盧建樹, 等. 尺骨莖突基底部骨折內固定對腕關節功能的影響. 中國組織工程研究, 2023, 27(36): 5840-5844.
17.	劉小智, 宋坤修, 馬丙棟, 等. 橈骨遠端骨折橈側移位對橈尺遠側關節穩定性的影響. 中華手外科雜志, 2019, 35(6): 437-440.
18.	Afifi A, Ali AM, Abdelaziz A, et al. Arthroscopic wafer procedure versus ulnar shortening osteotomy for treatment of idiopathic ulnar impaction syndrome: a randomized controlled trial. J Hand Surg (Am), 2022, 47(8): 745-751.
19.	王朋濤, 盧承印, 董家赫, 等. 腕關節鏡輔助治療老年橈骨遠端骨折合并三角纖維軟骨復合體損傷. 實用醫學雜志, 2022, 38(4): 405-409.
20.	Ajit Singh V, Jia TY, Devi Santharalinggam R, et al. Relationship of ulna styloid fracture to the distal radio-ulnar joint stability. A clinical, functional, and radiographic outcome study. PLoS One, 2023, 18(1): e0279210. doi: 10.1371/journal.pone.0279210.
21.	Nam JJ, Choi IC, Kim YB, et al. Clinical outcomes of arthroscopic one-tunnel triangular fibrocartilage complex transosseous suture repair are not diminished in cases of ulnar styloid process fracture nonunion. Arthroscopy, 2023, 39(1): 32-38.
22.	Niu HM, Wang QC, Sun RZ. Therapeutic effect of two methods on avulsion fracture of tibial insertion of anterior cruciate ligament. World J Clin Cases, 2022, 10(27): 9641-9649.
23.	萬豐, 汪松, 王遠, 等. 關節鏡下帶袢鈦板懸吊固定治療后交叉韌帶脛骨止點撕脫骨折. 中國修復重建外科雜志, 2024, 38(3): 267-271.
24.	趙銅林, 魏本磊. 鏡下穿雙骨道修復三角纖維軟骨復合體. 中國矯形外科雜志, 2024, 32(6): 553-556.

1. Velmurugesan PS, Nagashree V, Devendra A, et al. Should ulnar styloid be fixed following fixation of a distal radius fracture? Injury, 2023, 54(7): 110768. doi: 10.1016/j.injury.2023.04.055.
2. Tomori Y, Nanno M, Takai S. The presence and the location of an ulnar styloid fracture associated with distal radius fracture predict the presence of triangular fibrocartilage complex 1B injury. Arthroscopy, 2020, 36(10): 2674-2680.
3. 張琳袁, 劉志清, 王躍挺, 等. 尺骨莖突骨折對C型橈骨遠端骨折術后療效的影響. 中華手外科雜志, 2020, 36(3): 180-184.
4. Maniglio M, Truong V, Zumstein M, et al. Should we repair the pronator quadratus in a distal radius fracture with an ulnar styloid base fracture? A biomechanical study. J Wrist Surg, 2021, 10(5): 407-412.
5. Lutsky KF, Lucenti L, Beredjiklian PK. Outcomes of distal ulna fractures associated with operatively treated distal radius fractures. Hand (N Y), 2020, 15(3): 418-421.
6. 葉曙明, 徐春歸, 張積森, 等. 尺骨莖突骨折是否愈合對橈骨遠端骨折術后關節功能的影響. 中國組織工程研究, 2020, 24(33): 5321-5325.
7. Sarmiento A, Pratt GW, Berry NC, et al. Colles’ fractures. Functional bracing in supination. J Bone Joint Surg (Am), 1975, 57(3): 311-317.
8. 盧承印, 張海龍, 張來福, 等. 腕關節鏡下解剖修復Atzei-EWAS 2型三角纖維軟骨復合體損傷. 中國修復重建外科雜志, 2021, 35(11): 1417-1421.
9. 方凱彬, 王文懷. 腕關節鏡輔助治療關節內橈骨遠端骨折的早期療效觀察. 中國修復重建外科雜志, 2019, 33(2): 138-143.
10. Daun M, Rudd A, Cheng K, et al. Magnetic resonance imaging of the triangular fibrocartilage complex. Top Magn Reson Imaging, 2020, 29(5): 237-244.
11. Zlatkin MB, Rosner J. MR imaging of ligaments and triangular fibrocartilage complex of the wrist. Radiol Clin North Am, 2006, 44(4): 595-623.
12. Stuart PR, Berger RA, Linscheid RL, et al. The dorsopalmar stability of the distal radioulnar joint. J Hand Surg (Am), 2000, 25(4): 689-699.
13. Bayoumy MA, El-Sayed A, Elkady HA, et al. Arthroscopic treatment of type 1B triangular fibrocartilage complex tear by “outside-in” repair technique using transcapsular transverse mattress suture. Arthrosc Tech, 2017, 6(5): e1581-e1586.
14. Pidgeon TS, Crisco JJ, Waryasz GR, et al. Ulnar styloid base fractures cause distal radioulnar joint instability in a cadaveric model. Hand (N Y), 2018, 13(1): 65-73.
15. Kim KW, Lee CH, Choi JH, et al. Distal radius fracture with concomitant ulnar styloid fracture: does distal radioulnar joint stability depend on the location of the ulnar styloid fracture? Arch Orthop Trauma Surg, 2023, 143(2): 839-845.
16. 成帥, 江善勇, 盧建樹, 等. 尺骨莖突基底部骨折內固定對腕關節功能的影響. 中國組織工程研究, 2023, 27(36): 5840-5844.
17. 劉小智, 宋坤修, 馬丙棟, 等. 橈骨遠端骨折橈側移位對橈尺遠側關節穩定性的影響. 中華手外科雜志, 2019, 35(6): 437-440.
18. Afifi A, Ali AM, Abdelaziz A, et al. Arthroscopic wafer procedure versus ulnar shortening osteotomy for treatment of idiopathic ulnar impaction syndrome: a randomized controlled trial. J Hand Surg (Am), 2022, 47(8): 745-751.
19. 王朋濤, 盧承印, 董家赫, 等. 腕關節鏡輔助治療老年橈骨遠端骨折合并三角纖維軟骨復合體損傷. 實用醫學雜志, 2022, 38(4): 405-409.
20. Ajit Singh V, Jia TY, Devi Santharalinggam R, et al. Relationship of ulna styloid fracture to the distal radio-ulnar joint stability. A clinical, functional, and radiographic outcome study. PLoS One, 2023, 18(1): e0279210. doi: 10.1371/journal.pone.0279210.
21. Nam JJ, Choi IC, Kim YB, et al. Clinical outcomes of arthroscopic one-tunnel triangular fibrocartilage complex transosseous suture repair are not diminished in cases of ulnar styloid process fracture nonunion. Arthroscopy, 2023, 39(1): 32-38.
22. Niu HM, Wang QC, Sun RZ. Therapeutic effect of two methods on avulsion fracture of tibial insertion of anterior cruciate ligament. World J Clin Cases, 2022, 10(27): 9641-9649.
23. 萬豐, 汪松, 王遠, 等. 關節鏡下帶袢鈦板懸吊固定治療后交叉韌帶脛骨止點撕脫骨折. 中國修復重建外科雜志, 2024, 38(3): 267-271.
24. 趙銅林, 魏本磊. 鏡下穿雙骨道修復三角纖維軟骨復合體. 中國矯形外科雜志, 2024, 32(6): 553-556.

Chinese Journal of Reparative and Reconstructive Surgery

Comparative study of short-term effectiveness of three surgical methods for ulnar styloid base fracture complicated with triangular fibrocartilage complex injury

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