Biointegrative Radial Styloid ORIF Procedure

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Distal radius fractures are among the most common types of forearm fractures, describing any fracture of the radius that occurs close to the wrist_^1,2 . These injuries have a bimodal distribution, with a peak between 18 to 25 years of age, predominantly male population and a second peak in the elderly, older than 65 years, predominantly female population³. The Radial Styloid is a palpable bony prominence in the distal, radial side of the wrist. A Radial Styloid Fracture, also known as Chauffeur’s Fracture, is an intra-articular fracture of the medial distal radius. The anatomy surrounding the radial styloid is complex and the fracture fragment varies in size. The injury is often the result of a “Fall On an Outstretched Hand” (FOOSH) injury with a blow to the back of the wrist causing dorsiflexion and abduction compressing the scaphoid against the radial styloid^1,4. Nondisplaced fractures can be treated with plaster cast immobilization, however, since these fractures are intraarticular, surgical treatment is recommended in case of displacement, or when articular incongruity is greater than 2 mm_^2,4 . Acceptable treatment modalities for isolated radial styloid fractures include fixation with Kirschner wires, screws, volar plates, or fragment-specific radial buttress plates. While all these fixation types allow for bony union and acceptable functional results, they all pose the risk of recognized metal hardware complications, including infections, joint stiffness, tendon irritation, and/or tenosynovitis that eventually require implant removal^2,4. Biointegrative fixation implants can be a solution to overcome these complications as they eliminate subsequent implant removal².

CASE PRESENTATION

A 38-Year-old, right hand dominant, heavy laborer, male patient (weighing of 180 Lbs.). Sustained a fall while fishing, landing on a rock.
The right wrist presented moderate swelling with tenderness over the radial styloid and limited motion.

WHY OSSIOfiber^® IS AN IDEAL CHOICE FOR THIS PATIENT?

This patient did not want metal implanted, risking long term complications and potential
hardware removal. Furthermore, the OSSIOfiber^® implants do not obstruct visibility on imaging and help facilitate better follow up and evaluation of bone healing even on early post operative
radiographs.

Surgical Plan

Right Radial Styloid fracture fixation through percutaneous approach.

Size and length were templated on pre-op films.

The following OSSIOfiber^® fixation implants were used:

• OSSIOfiber^® 4.5X70mm Threaded Trimmable Fixation Nail (TTFN) x 1 unit

Surgical Technique

1. Access: Fluoroscopy-assisted approach through 3mm stab incision and blunt dissection carried down to the styloid.
2. Guide wire placed percutaneously in correct position under fluoroscopy, starting at the tip of the Radial Styloid, perpendicular to the fracture with the wire passing across the fracture site.
3. Fixation site preparation: Appropriate screw length then measured using the provided measuring tool.
4. Tunnel preparation: Drill passed over wire using oscillation to minimize soft tissue trauma.
5. Implant insertion: Implant cut to the appropriate length, 36mm, using sagittal saw, cutting of the distal tip and sharpened using the provided sharpener. Then, the implant is inserted over the-wire till countersink slightly under the bone surface. Alignment confirmed by fluoroscopy.
6. Closure: Steri-strip applied to the small incision for closure and volar splint for 1 week to immobilize and support the palm and wrist.

Technique Pearls:

1. Care should be taken to countersink the screw head into the cortex, to prevent soft tissue irritation.

Post-Operative Protocol

Volar splint removed on day 7 and patient transitioned to part time use of wrist brace for 4 weeks with immediate range of motion (ROM). Weight bearing as tolerated by 6 weeks.

Patient Follow-up:

Patient had minimal swelling and was able to begin ROM very quickly after the surgery. He was allowed for early mobilization with no casting. Two months x-rays demonstrate maintained alignment and advanced bone fusion.

Summary

The patient did very well post-operatively with ability to be back at his physically demanding work within a few weeks, having no concerns with retained hardware or need for implant removal procedures in the future.

References

1. Corsino, C. B., Reeves, R. A. & Sieg, R. N. Distal Radius Fractures. Green’s Oper. Hand Surgery, 8th Ed. 2-Volume Set 601–676 (2023) doi:10.1016/B978-0-323-69793-4.00015-8.
2. Turan, A., Kati, Y. A., Acar, B. & Kose, O. Magnesium Bioabsorbable Screw Fixation of Radial Styloid Fractures: Case Report. J. Wrist Surg. 09, 150–155 (2020).
3. Milutinović, S. M., Andjelković, S. Z., Palibrk, T. D., Zagorać, S. G. & Bumbasirević, M. Z. Distal radius fractures: Systematic review. Acta Chir. Iugosl. 60, 29–32 (2013).
4. Reichel, L., Bell, B., Michnick, S. & Reitman, C. A. Radial styloid fractures. J. Hand Surg. Am. 37, 1726–1741 (2012).