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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (3): 578-581. doi: 10.19723/j.issn.1671-167X.2020.03.027

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Effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function of patients with distal radius fracture

Peng ZHANG1,2,Bo JIA3,Xiao-kun CHEN3,Yu WANG3,Wei HUANG1,2,Ren-jie LAI3,Zhi-wei WANG3,Jian XIONG2,3,Tian-bing WANG1,2,3,△()   

  1. 1. Department of Trauma Center, Peking University People’s Hospital, Beijing 100044, China
    2. National Center for Trauma Medicine, Beijing 100044, China
    3. Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
  • Received:2018-08-16 Online:2020-06-18 Published:2020-06-30
  • Contact: Tian-bing WANG E-mail:wangtianbing@pkuph.edu.cn
  • Supported by:
    National Basic Research Program of China(973 Program);National Basic Research Program of China(2014CB542200);National Natural Science Foundation of China(31371210);National Natural Science Foundation of China(31771326);Beijing Natural Science Foundation(7204321);National Key Research and Development Program of China(2018YFF0301103)

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Abstract:

Objective: To study the effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function in patients with distal radius fracture.Methods: In total, 139 patients treated for distal radius fracture in the Department of Orthopedic Trauma at Peking University People’s Hospital from Jan. 2006 to June 2016 were selected for outpatient follow-ups. Evaluation was based on Sartiento’s modification of the Gartland and Werley scores. Efficacy was assessed with wrist pain as the focus.Results: The excellent and good efficacy rate was 97.1% (excellent: n=107, 77.0%; good: n=28, 19.4%; and fair: n=4, 2.9%). Gender, age, and whether the ulnar styloid fracture achieved union did not significantly impact the scores (P>0.05). The scores of the basal fracture group were significantly different (P=0.001). Internal fixation of ulnar styloid fracture was associated with a significant difference in scores (P=0.005). The effect of sigmoid notch fracture was also associated with a significant difference in scores (P=0.024). This study included 22 cases of ulnar wrist pain, and the overall incidence of ulnar wrist pain was 15.8%. Gender, age, whether the ulnar styloid fracture achieved union, and whether internal fixation was conducted for ulnar styloid fracture and sigmoid notch fracture had no significant effect on the occurrence of ulnar wrist pain (P>0.05). The incidence of ulnar wrist pain was higher in basal fractures than that in tip fractures. Among ulnar styloid fractures, the union rate of basal fracture was higher than that of tip fractures. The union rates of basal fracture and tip fracture were significantly different (P<0.001). Basal fractures were significant risk factors for ulnar wrist pain (P=0.028). Basal fracture of the ulnar styloid group and sigmoid notch fracture group had poor wrist function scores. Wrist function score improved significantly after internal fixation of ulnar styloid fracture. The incidence of ulnar wrist pain was higher in basal fracture group. The union rate in basal fracture group was higher than in tip fracture group.Conclusion: The overall effect of surgical treatment of distal radius fracture is satisfactory. Ulnar styloid basal fracture and sigmoid notch fracture are risk factors for postoperative wrist dysfunction in patients with distal radius fracture, and the basal fracture is one of the risk factors of ulnar wrist pain. The union rate of ulnar styloid basal fractures is better than that of tip fractures. Internal fixation of ulnar styloid fracture can improve wrist function.

Key words: Distal radius fracture, Sigmoid notch, Ulnar styloid fracture, Ulnar wrist pain

CLC Number: 

  • R658.2

Table 1

Linear regression analysis of Gartland and Werley score"

Items Gender, n Age/years,
x?±s		 Ulnar styloid
fracture, n		 Internal fixation of ulnar
styloid fracture, n		 Union of ulnar
styloid fracture, n		 Sigmoid notch
fracture, n
M F Basal Tip Y N Y N Y N
Gartland and Werley score
Excellent 23 84 55.4 ±1.3 33 44 12 64 26 51 18 89
Good 7 21 54.1±2.4 11 9 1 20 9 11 4 24
Fair 0 4 59.8±0.8 3 1 0 4 0 4 2 2
Poor 0 0 - 0 0 0 0 0 0 0 0
β 0.473 0.019 2.150 -1.229 -2.474 -0.688 2.093
SE 0.949 0.025 0.613 0.979 0.862 0.616 0.914
P 0.619 0.448 0.001 0.213 0.005 0.267 0.024

Table 2

Logistic regression analysis of ulnar wrist pain"

Items Gender, n Age/years,
x?±s		 Ulnar styloid
fracture, n		 Internal fixation of ulnar
styloid fracture, n		 Union of ulnar
styloid fracture, n		 Sigmoid notch
fracture, n
M F Basal Tip Y N Y N Y N
Ulnar wrist pain
Y 4 18 57.7±1.8 13 7 1 19 8 12 5 17
N 26 91 54.8±1.3 34 47 12 69 27 54 19 98
Incidence of ulnar wrist pain/% 13.3 16.5 - 27.7 13.0 7.7 21.6 22.9 18.2 20.8 14.8
Incidence of ulnar wrist pain/% 13.3 16.5 - 27.7 13.0 7.7 21.6 22.9 18.2 20.8 14.8
β -0.685 0.044 1.336 0.388 -21.010 0.249 0.902
SE 1.109 0.034 0.608 1.025 10 906.093 0.619 0.876
P 0.537 0.193 0.028 0.705 0.998 0.687 0.303

Table 3

Union rates of ulnar styloid fractures in different types"

Items Fracture union, n Fracture nonunion, n Union rate/%
Basal 27 20 57.4
Tip 8 46 14.8
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