Treatment with Buttress Plate Technique for Symptomatic Ulnar Styloid Base Nonunion

Abstract

Background Surgical treatment options for symptomatic ulnar styloid base nonunion can be divided into two groups: styloid excision and styloid fixation methods. Styloid fixation is commonly performed using tension band wiring or distal ulna hook plate. However, these methods are more suitable for large styloids than small ones. For this reason, fixation of small styloids still remains a problem. Purpose To present the surgical details and results of patients operated using the buttress plate technique, due to the symptomatic ulnar styloid base nonunion. Patients and Methods In this study, 11 patients who underwent surgery for symptomatic ulnar styloid base nonunion using buttress plate technique were evaluated retrospectively. The patients were evaluated with the help of forearm and wrist range of motion, grip strength, disabilities of the arm, shoulder, and hand (DASH) score and visual analogue pain score. Results The mean follow-up period was 15 months (range: 13-21 months). Union was achieved in 10 patients. At the final follow-up, the forearm supination and pronation active range of motions were significantly higher than those in the preoperative period, the visual analogue pain score mean value was 0.7 (range: 0-5), and the DASH score mean value was 7 (range: 1-32). Conclusion We conclude that good results can be achieved with the buttress plate technique in patients with both large and small fragmented ulnar styloid base nonunions and no distal radioulnar joint instability. Level of Evidence This is a Level IV, therapeutic study.

Keywords: buttress plate; distal radioulnar joint instability; ulnar styloid fracture; ulnar styloid nonunion; ulnar-sided wrist pain.

Fig. 1

A 56-year-old female patient operated for symptomatic ulnar styloid base nonunion (case 5). ( A ) Ulnar styloid base nonunion is seen in preoperative X-ray. ( B ) Nonunion line is seen in the intraoperative photograph. ( C ) Early postoperative X-ray. ( D ) Plain radiograph in the 6th postoperative month. ( E-F ) Two CT images at 6th postoperative month, view of union in one section and nonunion line that was not excised in another section.

Fig. 2

Surgical steps of the buttress plate technique for ulnar styloid base nonunion treatment. ( A ) Exposure of the nonunion line. ( B ) Excision of the proximal and distal nonunion lines. ( C ) Fixation of ulnar styloid using K-wire. ( D ) Placement of the plate to the distal ulna after plate shaping. ( E ) Drilling for the compression screw while the plate is pulled proximally. ( F ) View after the compression screw is inserted. After this step, one or two more screws are inserted.

Fig. 3

Treatment with buttress plate technique in a 39-year-old male patient with small fragmented ulnar styloid base nonunion (case 7). ( A, B ) Preoperative X-ray and CT images. ( C ) Early postoperative X-ray. ( D ) X-ray in the 9th postoperative month.