Ortho Dx: How Would You Treat This Ulnar Styloid Fracture? - Clinical Advisor

Ortho Dx: How Would You Treat This Ulnar Styloid Fracture?

Slideshow

  • Figure 1. Anteroposterior radiograph of the left wrist.

    CA_OrthoDx_012319_Image-1

    Figure 1. Anteroposterior radiograph of the left wrist.

  • Figure 2. Lateral radiograph of the left wrist.

    CA_OrthoDx_012319_Image-2

    Figure 2. Lateral radiograph of the left wrist.

A 28-year-old man presents to the office with left wrist pain after he fell on his outstretched hand. Anteroposterior and lateral radiographs (Figures 1 and 2) show a displaced distal radius and ulnar styloid fracture. The distal radius fracture is treated with open reduction and internal fixation.

How should the ulnar styloid fracture be treated?

Distal radius fractures are the most commonly seen fracture in the emergency department; many are also associated with ipsilateral ulnar styloid fractures.1 Treatment of distal radius fracture includes immobilization, closed reduction and immobilization, percutaneous pinning, and open reduction and internal...

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Distal radius fractures are the most commonly seen fracture in the emergency department; many are also associated with ipsilateral ulnar styloid fractures.1 Treatment of distal radius fracture includes immobilization, closed reduction and immobilization, percutaneous pinning, and open reduction and internal fixation.2,3 The significance of an ulnar styloid fracture with a distal radius fracture remains unclear.2 The ulnar styloid is the attachment site for the triangular fibrocartilage complex (TFCC), a cartilage structure that, along with connecting ligaments, supports the distal ulna and radius. The TFCC provides stability to the distal radioulnar joint (DRUJ) with grasping and forearm rotation. For this reason, the theory exists that ulnar styloid fractures disrupt the TFCC, causing DRUJ instability. However, no long-term differences in outcomes have been found between patients with a displaced ulnar styloid fracture and patients who have had a distal radius fracture alone.2

Wrist function after a distal radius fracture is not affected by a fracture of the ulnar styloid base. This is because restoring the distal radius position with open reduction and internal fixation provides DRUJ stability, and the TFCC eventually heals with immobilization. Ulnar styloid fractures often remain displaced well after the distal radius heals. Patients should be advised that although most ulnar styloid fractures never reduce, they should anticipate no effect on functional outcome.2,3

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).

References

  1. Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001;26(5):908-915.
  2. Zenke Y, Sakai A, Oshige T, Moritani S, Nakamura T. The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius. J Bone Joint Surg Br. 2009;91(1):102-107.
  3. Kim JK, Koh Y-D, Do N-H. Should an ulnar styloid fracture be fixed following volar plate fixation of a distal radial fracture?  J Bone Joint Surg Am. 2010;92(1):1-6.
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