Comparative Outcomes Between Three Different Techniques in the Fixation of Ulnar Styloid Fractures

Abstract

Purpose This study aims to compare the clinical and radiological outcomes of three different techniques used in the surgical treatment of ulnar styloid fractures.

Material and Method Ulnar styloid fractures treated surgically between 2012 and 2022 were evaluated retrospectively. There were three groups in the study: Group I (Kirschner wire, N= 19), Group II (tension band, N= 27) and Group III (headless compression screw, N= 25). The Gaulke classification was applied to categorise the fractures. After a follow-up period of at least one year, range of motion, Modified Mayo Wrist Score (MMWS), Quick Disabilities of the Arm, Shoulder and Hand Score (QDASH), Visual Analogue Scale (VAS) and grip strength were measured. In addition, radiological union, bone resorption and dorsal subluxation of the DRUJ were evaluated.

Results There was no difference between the three groups in terms of demographic data. Gaulke type 2 A was more frequently observed in all three groups (47.4%, 74.1%, 64%, respectively). Range of motion (flexion, extension, supination, pronation) was similar in all three groups (p>0.05). QDASH and MMWS were similar in all three groups. Grip strength was significantly lower in Group I than in Group II (p=0.039). Radiological outcomes (nonunion, dorsal subluxation, bone resorption) were similar in all three groups. Implant irritation was significantly higher in Group II (p=0.026).

Conclusion K-wires, tension band wiring and headless compression screws yield similar clinical and radiological outcomes in the surgical treatment of unstable ulnar styloid fractures. However, the need for secondary surgery is more frequent when a tension band is used. Level of Evidence: Level IV.

Zusammenfassung

Hintergrund Ziel dieser Studie ist es, die klinischen und radiologischen Ergebnisse von drei verschiedenen Techniken zur chirurgischen Versorgung von Frakturen des Processus styloideus ulnae (PSU) zu vergleichen.

Methode Die zwischen 2012 und 2022 operativ versorgten PSU-Frakturen wurden retrospektiv ausgewertet. Es gab drei Gruppen in der Studie: Gruppe I (Kirschnerdraht, n = 19), Gruppe II (Zuggurtung, n = 27) und Gruppe III (kopflose Kompressionsschraube, n = 25). Zur Klassifizierung der Frakturen wurde die Gaulke-Klassifikation verwendet. Nach einer Nachbeobachtungszeit von mindestens einem Jahr wurden der Bewegungsumfang, der Modified Mayo Wrist Score (MMWS), der Quick Disabilities of the Arm, Shoulder and Hand Score (QDASH), die Visuelle Analogskala (VAS) und die Griffkraft erhoben. Darüber hinaus wurden die radiologisch die Konsolidierung, die Knochenresorption und die dorsale Subluxation des DRUG bewertet.

Ergebnisse Hinsichtlich der demografischen Daten gab es keine Unterschiede zwischen den drei Gruppen. Der Gaulke-Typ 2 A war in allen drei Gruppen häufiger anzutreffen. (47,4%, 74,1% bzw. 64%). Der Bewegungsumfang (Flexion, Extension, Supination, Pronation) war in allen drei Gruppen ähnlich. (p > 0.05). QDASH und MMWS waren in allen drei Gruppen ähnlich. Die Griffkraft war in Gruppe I signifikant schwächer als in Gruppe II (p = 0.039). Die radiologischen Ergebnisse (Pseudarthrose, dorsale Subluxation, Knochenresorption) waren in allen drei Gruppen ähnlich. Die Implantatirritation war in Gruppe II signifikant höher (p=0,026).

Schlussfolgerung K-Draht, Zuggurtung und kopflose Kompressionsschraube haben ähnliche klinische und radiologische Ergebnisse bei der chirurgischen Behandlung instabiler Styloidfrakturen der Ulna. Die Notwendigkeit einer Sekundäroperation ist bei der Zuggurtung größer. Evidenzlevel: IV.

Keywords

headless compression screw - cross K wire - distal radioulnar joint - ulnar styloid process

Schlüsselwörter

kopflose Kompressionsschraube - K-Draht - distales Radioulnargelenk - Processus styloideus ulnae - Ulna-Styloid - Zuggurtung

Publikationsverlauf

Eingereicht: 06. März 2024

Angenommen: 31. Oktober 2024

Artikel online veröffentlicht:
15. Januar 2025

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