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Abstract
Purpose:
There remains uncertain whether to fix or not an ulnar styloid fracture acommpanied by distal radius fracture. Fixation might be required in cases of the fracture involving a fovea of ulnar head, an attachment site of deep triangular fibrocartilage, which is thought to be important to distal radioulnar joint stability. We analyzed a fovea involvement of an accompanied ulnar styloid fracture in patients with distal radius fracture by simple radiograph and three-dimensional computed tomography (3D CT).
Methods:
We retrospectively reviewed 168 patients who underwent surgery with volar locking plate for distal radius fracture in our hospital from January 2005 to March 2015 and evaluated a fovea involvement of ulnar head by simple radiographs and 3D CT respectively, and compared.
Results:
On simple X-ray, 64 cases (38%) were ulnar styloid fovea fractures; however, 21 cases of these revealed non-fovea fractures by 3D CT. And 7 out of 104 cases determined as non-fovea fracture by simple radiographs were diagnosed as fovea fractures by 3D CT. Sensitivity, specificity and accuracy of evaluation by simple radiograph were 86%, 82% and 83% respectively, when compared with those of 3D CT based evaluation.
Conclusion:
Accuracy of evaluating an accompanied ulnar styloid fovea fracture in patients with distal radius fracture by simple radiograph, when compared with 3D CT, was 83%; therefore, we recommend using the 3D CT based evaluation instead of simple radiograph based one for determination of fovea involvement of ulnar head.
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Fig. 1.
Fovea of ulnar styloid process. (*, asterisk in dotted line). (A) Axial view of three-dimensional computed tomography (3D CT) reconstruction image. (B) Anteroposterior-oblique view of 3D CT reconstruction image.
Fig. 2.
Initial posteroanterior radiographs (A) of right wrist of 82-year-old female patient showed ulnar styloid base fracture. It seems like that there is a fovea involvement of fracture line on simple radiograph, but, considering computed tomography reconstruction centered by styloid process (B), fovea is not involved, and deep triangular fibrocartilage was supposed to be intact.). Radiograph taken at postoperative 6 months (C) shows a healed fracture of styloid process without surgery.
Fig. 3.
Initial posteroanterior radiograph of left wrist of 61-year-old lady (A) was interpreted as non-base fracture of ulnar styloid, but the coronal (B) and three-dimensional (3D) reconstruction image (C) of computed tomography scan showed a fovea involvement. 3D reconstruction image (C) revealed more clear figuration of displaced styloid fragment with foveal beak.
Table 1.
Distribution of ulnar styloid base and non-base fracture evaluated by simple radiograph and 3D CT
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