In conclusion, the results of distractor application for intra articular distal radius fracture (AO types B and C) with ulnarstyloid involvement on radial side alone are better than application on both radial & ulnar sides. Fur- thermore, it is seen that on application of distractor on either sides of a forearm, there is a chance of collapse of the radial fracture fragment. This is probably due to ulnar stretching that distorts the normal anatomical relation between the two styloids (i.e., the radial styloid being at a lower level compared to the ulnarstyloid). Also, only 30% patients with distractor on radial side required re- peat distraction at 2 weeks whereas 75% patients with distractor on both sides necessitated distraction.
unstable ulnarstyloid fractures, and both soft tissue and bony structures should be properly addressed to avoid late complications. In our series, a TFCC tear was found in 10 patients who underwent suture anchor repair during sur- gery. Concomitant soft tissue injuries around the DRUJ were commonly found with ulnarstyloid fractures and could be overlooked with nonsurgical treatment. Our results suggested that early detection and surgical manage- ment achieved significantly better functional outcomes with fewer complications than with late intervention. Lower average pain scores were also found in the group with early fixation. While the difference was not significant, most pa- tients showed no pain or only mild residual pain in both groups. This confirmed the effects of surgical intervention.
Detailed anatomical knowledge of distal end of ulna plays a pivotal role in understanding post injury instability and painful conditions at distal radioulnar joint, which can be due to avulsion of ulnarstyloid process or styloid triquetral impaction syndrome 5 . The importance of the ulnar side of the wrist is being considered more carefully as more and more surgeons realize that in order to improve the outcome after distal forearm fractures, the ulnar side needs more attention 6 .
and reduced with a bone clamp, we evaluated the reduc- tion of the articular surface of the radius by arthroscopy using 3–4 and 4–5 portals in the radiocarpal joint using a 30° oblique, 1.9-mm arthroscope (Stryker K.K., Tokyo, Japan). There were less than a 1-mm gap and step-off in the articular surface; therefore, we judged that the ar- ticular surface was acceptably reduced. We tried to re- duce the fragment of the ulnarstyloid, but we could not visualize the ulnar side because of the triangular fibro- cartilage complex (TFCC), which extended to the radial side (Fig. 2a). Next, arthroscopy of the DRUJ was per- formed using distal and proximal DRUJ portals, and this
Anatomic and biomechanical studies have demon- strated that, besides the TFCC, the distal interosseous membrane, the extensor carpi ulnaris, the pronator quadratus and the congruence between the sigmoid notch of the distal radius and the ulnar head all contrib- ute to the DRUJ stability [29,38]. These studies explained why DRUJ instability complicated to DRF rarely oc- curred. Clearly, some ulnarstyloid fractures do result in DRUJ instability, and we believe that treating the ulnarstyloid fracture with open reduction and internal fixation is generally supported. The question we attempted to answer in the present study was if the DRUJ is stable, what effect an ulnarstyloid fracture may have on the outcome of the DRF. In our study of the patients whose unstable DRF had been treated with closed reduction and external fixation, we were unable to detect any sig- nificant difference in the radiological findings, the range of wrist motion, the grip strength, the PRWE-HK scores, and the wrist pain scores among the three patient groups at the external fixator removal time, three months posto- peratively and the final follow-up visit. Our results suggest that an untreated ulnarstyloid fracture does not affect the wrist outcomes of the patient with unstable DRF, provided that the patient’s DRUJ is stable.
superficially running over the Extensor Indices Proprius. We proceed distally by carefully dissecting the sub-epimyseal plane of APL, EPL and EIP. There were multiple perforators to APL, one to EIP and two to EPL in all our dissections which were ligated during raising of the flap. Distally the PIA runs very close to the periosteum of ulna, radial to the ECU which is situated in the groove on the dorsal surface of ulnarstyloid. From there on the ulnar directed smooth arch like bending of the artery runs beneath Extensor Digiti Minimi and Extensor Digiti Communis to make anastomosis with the Anterior Interosseous Artery.
Fig. 3 Images from 3 T study. Top images are showing that at the level of the disc of TFCC, the ulnarstyloid is out of plane. Middle images show ulnarstyloid with TFCC disc out of plane. Bottom images: axial, left, from which oblique multi-planar reconstruction (MPR), right, was made (with green line in bottom left image indicating direction of oblique coronal plane). Blue arrow showing wavy fibers and focal defect compatible with partial tear of the distal lamina of the triangular ligament, which is not seen with standard coronal imaging due to orientation of the ligament and slice selection. (R-radius, U-ulna, S-scaphoid, L-lunate, T-triquetrum, < − extensor carpi ulnaris in middle images)
screws. Plating allows direct visualization of fracture fragments and restoration of the anatomy, decreased morbidity by allowing early mobilization, and early return of wrist function. Locking plates address intra-articular and metaphyseal comminution and are very helpful in osteoporotic fractures preventing late collapse of fracture fragments. Biomechanical studies comparing volar fixed- angle locking plates with that of conventional dorsal plates report volar fixed-angled plates to be superior in terms of their strength. Dorsal plating of distal radius has not gained popularity due the fact that, inspite of dorsal plating, the volar collapse of fracture occurred . Complications associated with plating include risk of infection as compared to closed procedures, tendon irritation or rupture. These may warrant implant removal in some cases. DRUJ instability was previously recognized as a poor prognostic factor in the management of distal radius fractures. However, studies suggest that anatomically reduced and rigidly fixed distal radius fractures with locking plates have no significant difference in the final functional outcome between patients treated with and without ulnarstyloid fractures, despite the degree of displacement and the location of the fractures . In our study, seven (13.20%; 2 23-A3,1 23-B2,1 23-B3, 1 23-C2 and 2 23-C3) patients, diagnosed to have DRUJ instability intraoperatively underwent additional radio-ulnar K-wire fixation. The K-wire was removed in the Out-Patient Department after 4 weeks. These patients had reduced pronation at 6 weeks of follow-up but there was no difference compared to the non-fixed group at the end of 3 months. DRUJ fixation had no negative impact on the outcome of the study at the end of 1 year follow-up.
The results from the MRI showed no convincing injury of the TFCC. There was a small amount of marrow edema along the base of the ulnarstyloid but no associated frac- ture. It was thought that this could refl ect a small area of bone bruising. After receiving the results from the MRI, the patient still felt something was wrong and decided to go ahead with the MRA.
Background: The compression of the median nerve (MN) in the carpal tunnel (CT) is one of the most common aetiologies of entrapment neuropathy syndromes in clinical practice. The aim of this study was to investigate the relationship of the palpable bony prominences of the distal forearm (radial styloid process [RSP] and ulnarstyloid process [USP]) with MN in the CT, in order to determine a safe-zone of the MN during carpal tunnel procedures.
When there is a fall on the outstretched hand with wrist in dorsiflexion and the forearm in pronation initially when the hand comes in contact with the ground, the volar cortex fails due to tension and fractures following which there is compression in the dorsal cortex which also fails resulting in communition in the dorsal cortex. This results in distal radius fractures with dorsal displacement. Transfer of load along the triangular fibrocartilage complex can result in fracture of the ulnarstyloid (17) .
A total of 19 of the 398 articles and abstracts met five or six literature classification criteria; six of these articles were excluded from subsequent analysis for various reasons. For example, some investigators performed ulnar nerve conduction studies (NCSs) in the course of looking primarily at other phenomena, such as the effects of age on the conduction properties of multiple nerves, the correlation between clinical and electrodiagnostic findings, or the difference between proximal and distal nerve segments; the findings therefore have scant or no applicability to the evaluation of the clinical problem of UNE. Studies of normal control subjects met a maximum of five of five criteria; studies of patients with UNE met a maximum of six of six criteria.
The elongation occurs most commonly as a result of a post-traumatic proliferation of the styloid bone, calcification of the SHL or an abnormal elongation of the SP by 30 mm or more . The possibility of its being a recessive genetic disorder could also be included. Cranial nerves which could be involved include the trigeminal, facial, glossopharyngeal, vagus, spinal accessory and hypoglossal nerves. The occasional carotid plexus and cervical plexus involvement can produce a wider symptomatology [8-9].
Introduction: The styloid process arises from petrous part of temporal bone as an osseous projection and shows considerable anatomic variability. The elongated styloid process presents with various signs and symptoms. The manifestations may vary widely such as cervicofacial pain, cerebral ischaemia and even death. Diagnosis can be made by clinical evaluation and different imaging modalities of which Cone Beam Computed Tomography(CBCT) gives a more accurate measurement. The morphological knowledge of styloid process and its variation is essential as it has various clinical implications in the field of dentistry, cardiology and forensic sciences.
Dynamic imaging of the cubital tunnel is performed either with the patient seated and the elbow placed on a stiff pillow or, at least for the right side, with the patient supine and the arm abducted, hanging over the table. The position of the ulnar nerve and the medial head of the triceps relative to the medial epicondyle is assessed throughout elbow flexion while placing the probe in the transverse plane with one edge on the olecranon and the other on the medial epicondyle. During this manoeuver, it is important to avoid pressing the transducer too firmly on the skin as it may prevent the anterior dislocation of the nerve from the tunnel.
A 33-year-old Bahraini lady with a chronic history of recurrent attacks of tonsillo-pharyngitis and a persistent sensation of sore throat and odynophagia of more than 2 years’ duration. There was no history of localized facial or neck pain, or foreign body sensation. She was booked for a routine tonsillectomy procedure. After a complete removal of both tonsils by cold dissection method and control of bleeding by electro cautery, an elongated ap- parent styloid process was noticed in the bed of the right tonsillar fossa, while the left side showed a slight bulge behind the superior constrictor muscle (Figure 1).
The patient underwent a nerve conduction study (NCS) with EMG of his upper extremities. Sensory nerve conduction studies showed normal right median and ulnar sensory nerve action potentials. The motor nerve conduction studies of the right ulnar abductor digiti minimi showed low-amplitude compound motor action potentials (CMAPs) with normal latency and conduction velocity (CV). Right ulnar ﬁrst dorsal interosseous (FDI) showed no slowing across the elbow. Right median abductor pollicis brevis CMAPs had normal latency, amplitude, and CV. Needle EMG showed normal insertional activity in both arms and in the cervical para- spinals. The motor unit action potentials in the right FDI, extensor indicis proprious, and extensor digitorum communis were large with reduced recruitment.
Nerve conduction studies showed conduction block in left ulnar and median nerves in the forearm, along with mildly slowed sensory velocities of bilateral ulnar and left sural and right median nerve. Sensory nerve action potential amplitudes were mildly reduced in multiple nerves (bilateral median and radial, right ulnar, and left sural). The F-wave latency of left ulnar nerve was also prolonged (;130% of normal). Needle EMG showed neuropathic units in L4/5, L5/S1, and C7-T1- innervated muscles. These ﬁndings are consistent with the presence of multiplex mononeuritis with demyelinating pat- tern and polyradiculopathy.
The literature search was conducted on PubMed in the week of 5 November 2012. An additional search for updates on the literature was performed on 1 May 2013. No MeSH terms were available for this subject; therefore the following keywords were used: ‘skier’s thumb, ’ ‘ulnar AND collateral AND ligament, NOT elbow, ’ ‘UCL, NOT elbow’ and ‘gamekeeper’s thumb.’ Filters applied were studies in humans and publications in English. Recent articles were preferred; however due to the limited amount of information available about this subject, articles of older dates were also reviewed. Additional information concerning our own hospital was worked out by the primary author.
Generally, parapharyngeal space (PPS) tumours are less than 1% of all head and neck tumours . Most PPS tumours are benign (70-80%). The malignant ones are fewer. The post - styloid compartment lesions tend to be of neurogenic origin whereas the prestyloid ones arise from the minor salivary glands in the lateral pharyngeal wall or extensions of tumours of the deep lobe of the parotid . Among the benign tumours of the PPS, the pleomorphic adenoma is the commonest . We present a case of a left parapharyngeal mass which caused a cerebrovascular accident (CVA) and was excised transorally with resolution of the CVA. We believe that the left parapharyngeal tumour in our case was compressing on the ipsilateral carotid sheath and therefore by inference on the walls of the internal carotid artery thus limiting the blood supply to the left half of the brain. This led to the left brainstem infarct with the resultant right hemiparesis. The occluded vessel recanalized after the tumour was excised with resolution of