Efficacy of arthroscope-assisted reduction and anchor fixation in the treatment of old ununited fractures of the ulnar styloid process combined with triangular fibrocartilage complex injury
Objective To investigate the efficacy of arthroscope-assisted reduction and anchor fixation in the treatment of old ununited fractures of the ulnar styloid process combined with triangular fibrocartilage complex(TFCC)injury.Methods A retrospective case series study was conducted to analyze the clinical data of 30 patients with old ununited fractures of the ulnar styloid process combined with TFCC injury(with pressing pain of the ulnar wrist and decreased grip strength)admitted to Sichuan Provincial Orthopedic Hospital from June 2018 to June 2023,including 18 males and 12 females,aged 40-54 years[(47.6±5.4)years].All the patients had Hauck type Ⅱ fractures.A total number of 17 patients had fractures on the left side and 13 on the right side.Arthroscope-assisted reduction and anchor fixation of the ulnar styloid process were performed and the injured TFCC was repaired simultaneously.The visual analogue scale(VAS)scores for ulnar-sided wrist pain before surgery,at 3 and 6 months after surgery,and at the last follow-up were compared.Anteroposterior and lateral X-rays of the wrist joint were taken at 1-6 months after surgery to observe the fracture healing.The ranges of motion of wrist flexion and extension,wrist radial-ulnar deviation,and forearm rotation,Cooney wrist function scores,and grip strengths before surgery,at 3 and 6 months after surgery,and at the last follow-up were compared.The occurrence of intraoperative and postoperative complications was observed.Results All the patients were followed up for 12-16 months[(13.5±2.3)months].At 3,6 months after surgery and at the last follow-up,the VAS scores for ulnar-sided wrist pain were(3.1±0.8)points,(1.4±0.8)points,and(1.2±0.5)points respectively,which were all lower than(7.1±0.8)points before surgery(P＜0.05).The VAS scores at 6 months after surgery and at the last follow-up were lower than that at 3 months after surgery(P＜0.05),while there were no significant difference between the scores at 6 months after surgery and at the last follow-up(P＞0.05).Fractures healed well in the 28 patients,with the healing time of 3-4 months[(3.0±1.3)months],while 2 patients had delayed union.There were no significant differences in the ranges of motion of wrist flexion and extension or radial-ulnar deviation before surgery,at 3 and 6 months after surgery,and at the last follow-up(P＞0.05).At 3,6 months after surgery and at the last follow-up,the ranges of motion of forearm rotation were(149.9±10.8)°,(158.6±10.5)°,and(159.0±11.1)°respectively,which were all greater than(131.7±11.0)°before surgery.The ranges of motion of forearm rotation were greater at 6 months after surgery and at the last follow-up than that at 3 months after surgery(P＜0.05),while there were no significant difference between the angles at 6 months after surgery and at the last follow-up(P＞0.05).At 3,6 months after surgery and at the last follow-up,the Cooney wrist function scores were(51.7±5.8)points,(74.8±6.2)points,and(84.3±6.6)points respectively,which were all higher than(39.8±6.1)points before surgery(P＜0.05),and the scores gradually increased at each time point after surgery(P＜0.05).At the last follow-up,the Cooney wrist function scores of 13 patients were evaluated as excellent,15 good,and 2 fair,with an excellent and good rate of 93.3％.At 3,6 months after surgery and at the last follow-up,the grip strengths of the affected side were(21.6±2.5)kg,(36.6±2.5)kg,and(45.7±5.8)kg respectively,which were all greater than(14.6±2.5)kg before surgery(P＜0.05),and the grip strengths gradually increased at each time point after surgery(P＜0.05).No bone fragment fragmentation occurred during the surgery.No internal fixation failure occurred after the surgery,and there was no secondary ulnar tissue irritation or injury to the dorsal branch of the ulnar nerve.Conclusion Arthroscope-assisted reduction and anchor fixation in the treatment of old ununited fractures of the ulnar styloid process combined with TFCC injury has advantages of good bone and soft tissue healing,relieved wrist pain,increased grip strength,improved wrist rotation range and function,and fewer complications.
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