How are ulnar styloid fractures characterized?

Updated: Apr 26, 2021
  • Author: David M Lichtman, MD; Chief Editor: Harris Gellman, MD  more...
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Patients with these fractures present with a limited range of motion, grip weakness, and ulnar wrist pain that is exacerbated by ulnar deviation and twisting the wrist. Clinically, tenderness at the ulnar snuffbox, and possibly swelling and ecchymosis, are present, depending on the timing of the patient's presentation. The DRUJ is assessed for stability by using the piano-key test. Routine radiographs may not reveal a fracture; CT scans may be beneficial.

Because the TFCC attaches to the base of the ulnar styloid, fractures at the tip that remain and continue to be painful after failed conservative treatment may be treated with excision. Nondisplaced or minimally displaced acute fractures at the base of the styloid should be treated with cast immobilization with the wrist in the neutral position and slightly ulnarly deviated for 6 weeks.

Displaced fractures that are associated with distal radius fractures often reduce with the reduction of the distal radius. Large styloid fractures at the base that are associated with DRUJ instability and that remain displaced by more than 2-3 mm require open reduction and internal fixation (ORIF) with either a small fragmentation screw or tension banding and cast immobilization for at least 6 weeks.

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