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J Wrist Surg 2021; 10(05): 385-391
DOI: 10.1055/s-0041-1726309
Scientific Article

The Critical Size of Ulnar Styloid Fragment for the DRUJ Stability

Mauro Maniglio 
1   Department of Orthopaedics and Traumatology; Inselspital Bern, University Hospital, Bern, Switzerland
,
Il Jung Park
2   Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California
,
Matthias Zumstein 
3   Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
,
Michael Kuenzler
1   Department of Orthopaedics and Traumatology; Inselspital Bern, University Hospital, Bern, Switzerland
,
Michelle H. McGarry
2   Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California
,
Thay Q. Lee
2   Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California
› Author Affiliations Funding None.
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Abstract

Background Ulnar styloid fractures can be associated with clinically significant instability of the distal radioulnar joint (DRUJ). However, the exact fragment size that results in DRUJ instability is unknown.

Purpose The objective of this study was to determine the critical size of an ulnar styloid fracture that would result in a significant increase in DRUJ translation and forearm rotation.

Methods Eight cadaveric specimens were used to investigate the effects of three different ulnar styloid fracture sizes on DRUJ instability: tip fracture, base fracture, and a fracture including the fovea. Forearm rotation and dorsopalmar DRUJ translation were measured after each sequential increase in fracture size.

Results Relative to the uninjured state, a significant increase in forearm rotation and dorsopalmar translation was found for all three fractures. However, the fovea fracture showed a statistically significant increase in forearm rotation compared with all other fracture types and a statistically significant increase in total dorsopalmar translation compared with the tip fracture.

Conclusion In this study, ulnar styloid fractures involving the fovea resulted in significantly greater DRUJ instability comparted to tip and base fractures alone. This study provides important biomechanical data regarding the critical size of ulnar styloid fractures that result in DRUJ instability and may aid in the surgical decision-making algorithm in these patients.

Keywords

distal radioulnar joint - distal radioulnar ligaments - distal radius fracture - TFCC - ulnar styloid fracture

Ethical Approval

Ethical approval for this study was obtained from Institutional Review Board of VA Hospital Long Beach UCI.




Publication History

Received: 21 July 2020

Accepted: 03 February 2021

Article published online:
24 March 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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