Effect of ulnar styloid fracture on outcomes after conservative treatment of distal radius fracture.

OBJECTIVES: This study aims to investigate the effect of accompanying ulnar styloid fracture (USF) on clinical outcomes and hand-wrist muscle strength in conservatively treated active patients after displaced distal radius fracture (DRF). PATIENTS AND METHODS: The retrospective study, which was conducted November 2012 and September 2016, included 56 patients (34 males, 22 females; mean age 28.8 years; range 20 to 40 years) with displaced DRF treated with closed reduction and casting. Patients were divided into three groups according to ulnar styloid status as group A (intact ulnar styloid), group B (USF non-union), and group C (healed USF). Grip strength, quick-disabilities of the arm, shoulder and hand (DASH) score, and joint range of motions were evaluated; the results were combined with measurements of isokinetic muscle strengths of hand-wrist region. Magnetic resonance imaging was performed to evaluate the accompaniment of distal radioulnar joint injury and triangular fibrocartilage complex (TFCC) lesion. RESULTS: There were no significant differences between the groups regarding joint range of motion, grip strength, and quick-DASH scores. However, the peak torque and total work of supination was better in group A compared to group B (p=0.008 and p=0.006, respectively). According to the magnetic resonance imaging findings, of the 10 patients with detected TFCC lesion, four were in group C, five in group B, and one was in group A. CONCLUSION: Results of this study suggest that USF should not be the focus of attention during initial treatment of DRF and surgical intervention might be considered in case of an accompanying TFCC lesion.

Clinical and radiological outcomes of conservative treatment after stable post-traumatic thoracolumbar fractures in elderly: Is it really best option for all elderly patients?

OBJECTIVE: The purpose of this study was to research the effectiveness of conservative treatment of stable post-traumatic thoracolumbar vertebral fractures in elderly patients. METHODS: The study included 21 elderly patients (13 females, 8 males) with post-traumatic thoracolumbar compression fracture who were treated with a brace. Fractures without any trauma history, pathological fractures, patients younger than 60 years old and patients with no malignancy history were excluded from study. Neurological examination and posterior ligamentous complex (PLC) were intact in all patients. Radiological parameters and pain scores were recorded in regular follow-up. RESULTS: The mean age and follow-up were 71.3 years (range, 60-84 years) and 20.1 months (range, 12-26 months) respectively. During follow-up, 4 patients had significant height loss resulting in kyphotic deformity and intractable pain. There was a significant increase in the local kyphosis angle (p = 0.001) and height loss percentage (p = 0.017). At the final follow-up, the mean Denis Score of pain was 1.62 ± 0.74. CONCLUSION: Although there is wide acceptance of conservative treatment of post-traumatic stable thoracolumbar fracture with intact PCL according to the Thoracolumbar Injury Classification and Severity Score (TLICS), elderly female patients with a post-traumatic compression fracture in the junctional region are at great risk of conservative treatment failure. These patients should be well-informed about the possible complications and poor results of conservative treatment, and surgical treatment should be considered in selective cases with the informed consent of the patients.