L’objectif de la prise en charge est d’éviter l’apparition d’une instabilité chronique et/ou de lésions arthrosiques alors accessibles uniquement à des solutions palliatives. L’examen clinique doit définir l’ensemble des structures lésées, permettant de définir une stratégie à la carte de la reconstruction de ces différentes structures. Sa prise en charge nécessite une connaissance précise de l’ensemble des structures anatomiques. L’instabilité radio ulnaire distale est une entité clinique fréquente qui peut se présenter sous une forme aiguë ou chronique. Whether you choose to approach the problem arthroscopically or open, the foveal TFCC tear should be repaired to prevent long-term sequalae. One thing we know for sure is that foveal tears of the deep fibers of the TFCC, with or without ulnar styloid fracture (Palmer 1B, Atzei class 2 or 3), can produce distal radioulnar joint (DRUJ) instability and wrist dysfunction and should be addressed sooner rather than later to prevent long-term consequences, including DRUJ osteoarthritis. Recent research shows that we may not need to excise or repair the ulnar styloid fracture nonunion fragment, which in turn may help preserve the complex ligamentous architecture that stabilizes the ulnar-sided wrist. Treatment of these injuries has historically included open TFCC repair with fixation or excision of the ulnar styloid fracture nonunion fragment however, recent literature suggests that addressing the ulnar styloid nonunion fragment may not be as important as we think. Deep/foveal tears of the triangular fibrocartilage complex (TFCC) may occur in the setting of nonunited ulnar styloid process fractures. Occasionally, however, wrist trauma results in multiple concurrent and overlapping injuries that make diagnosis and treatment of these conditions challenging. The ulnar-sided wrist contains multiple potential pain generators that may present in isolation. The other authors have no financial disclosures to report. Wijffels received funding for this research project from the Bontius Stichting, without any influence on patient selection or data analysis. A meta-analysis based on these studies, Conflict of interest statement However, as randomisation for ulnar styloid union will never be possible, observational studies are the highest level of evidence available for single studies. This might limit the clinical relevance of operative USP fracture fixation. In conclusion, the results of this meta-analysis indicate that the consolidation status of an accompanying USP has no influence on the patient-reported outcome nor on function, pain, or DRUJ instability after a healed DRF. Raw data were available for three out of the six Discussionīased on the available data, no influence of the osseous union status of the fractured ulnar styloid in adult patients with a DRF could be demonstrated regarding patient-reported outcome, range of motion, presence of pain, or presence of DRUJ instability. These studies included a total of 135 patients in the union group and 230 in the nonunion group. Eight studies met our inclusion criteria however, two studies did not report sufficient data to be included in the meta-analysis leaving six studies available for meta-analysis, ,, ,. The search resulted in 488 potentially eligible studies, of which 17 full text articles were analysed for eligibility (Fig. The meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The primary aim of this meta-analysis was to compare functional outcome between patients with and without the union of an ulnar styloid and a healed DRF. Therefore, a meta-analysis was performed to provide the best available evidence. To date, the relation between USP nonunion and outcome in patients with DRFs is unclear, due to the conflicting results and small sample sizes of the published studies. Others found that nonunion of the ulnar styloid did not affect functional outcome or pain following volar plate fixation of a DRF, ,, ,. Mentzel and colleagues reported a better residual function if the USP fracture unites. Nonunion of the USP fracture has been proposed as a potential source of ongoing ulnar-sided wrist pain and DRUJ instability. Ulnar styloid avulsion may result in distal radioulnar joint (DRUJ) instability due to triangular fibrocartilage complex (TFCC) disruption, the principal stabilizer of the DRUJ, ,, ,. Displacement of DRFs may result in disruption of the distal radioulnar ligaments, either by direct ligamentous tear or by avulsion of the origin of the ligaments, that is, a fracture at the ulnar fovea or the ulnar styloid, ,, ,, ,, ,,. Of those patients, 44–65% also have an ulnar styloid process (USP) fracture,. One in six patients who present with a fracture at the emergency department has a distal radius fracture (DRF).
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