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J Wrist Surg 2021; 10(02): 111-115
DOI: 10.1055/s-0040-1719041
Scientific Article

Relationship between Fracture of the Ulnar Styloid Process and DRUJ Instability: A Biomechanical Study

Toshiyasu Nakamura
1   Hand Center of Western New York, State University of New York at Buffalo, Buffalo, New York
2   Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan
,
Owen J. Moy
1   Hand Center of Western New York, State University of New York at Buffalo, Buffalo, New York
,
Clayton A. Peimer
1   Hand Center of Western New York, State University of New York at Buffalo, Buffalo, New York
3   Department of Orthopaedic Surgery, Marquette General Hospital, Marquette, Michigan
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Abstract

Background There has been clinical question in the treatment of ulnar styloid fracture with distal radius fracture, surgical fixation of the styloid fragment, or ignorance of the fragment. We examined relationship between size of the ulnar styloid fracture and distal radioulnar joint (DRUJ) stability biomechanically to answer the above clinical question.

Methods Changes in the dorsopalmar stiffness of the DRUJ after experimentally simulating in four types of ulnar styloid fractures were examined in cadavers. After tip, middle, base-horizontal, and base-oblique type of styloid fractures were made sequentially, changes in dorsopalmar DRUJ stiffness were measured using the MTS machine in the intact wrist, for each fracture, at 60 degrees pronation, neutral, and 60 degrees supination, respectively. Additional cutting of the radioulnar ligament (RUL) at the fovea was also simulated with the base-horizontal fracture.

Results The tip and middle type fractures did not demonstrate significant loss of stiffness compared with the intact. The base-horizontal fracture demonstrated only significant loss of stiffness in the dorsal direction (radius palmar; ulnar dorsal) with forearm in neutral rotation. The base-oblique fracture demonstrated significant loss of dorsopalmar stiffness of the DRUJ. Additional section of the RUL with the base-horizontal fracture induced significant loss of stiffness of the DRUJ compared with the intact.

Conclusions Because the RUL originates from the fovea as well as from the base of the ulnar styloid, these results suggest that DRUJ instability closely correlates with how much of the bony fragment includes the originating portions of the RUL. The findings further suggest that larger base-oblique and base-horizontal fragments with resultant DRUJ instability must be reattached, but that even base-horizontal fragment as well as tip and middle ulnar styloid fragment can be ignored when there is no instability.

Keywords

ulnar styloid - fracture - radioulnar ligament - distal radioulnar joint instability

Ethical Approval

This study was conducted under the guidance of Clinical Anatomy Laboratory of our university in accordance with the “Guidelines for autopsy in clinical medicine education and research.”




Publication History

Received: 06 August 2020

Accepted: 28 August 2020

Article published online:
04 November 2020

© 2020. Thieme. All rights reserved.

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