Executive Editor: Steve Krikler

Authors: Renato Fricker, Jesse Jupiter, Matej Kastelec

Distal forearm Extraarticular fracture of the ulnar styloid process

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Glossary

General considerations

The ulnar styloid may be fractured at its tip, through the body, or through its base (basi-styloid fracture). The level of injury has implications for the integrity of the attachment of the triangular fibrocartilage complex (TFCC) and the stability of the distal radioulnar joint (DRUJ). If the injury involves these structures, they may also require fixation.
A Galeazzi or Essex-Lopresti type of injury may also be present.
Any patient who has had a fall on the outstretched hand may have sustained an intercarpal ligament injury; these may easily be missed on initial clinical assessment.

Nonoperative treatment - Cast
Main indication Skill Equipment
Stable wrist and DRU joint Basic surgical experience, no specialized skills Basic equipment only

Indications

  • Undisplaced
  • Simple (noncomminuted)
  • Stable distal radioulnar joint
  • Low-demand patient

Contraindication

  • Unstable distal radioulnar joint

Disadvantage

  • Increased risk of long-term mobility loss
ORIF - Tension band wire
Main indication Skill Equipment
Unstable, small fragment Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Small fragment of the ulnar styloid
  • Widely displaced fracture
  • Unstable fracture
  • Comminuted fracture (relative indication)
  • Unstable DRU joint

Contraindications

  • Local soft-tissue injuries
  • Poor condition of overlying soft-tissue envelope
  • Patient not fit for surgery

Advantages

  • Early mobilization
  • Healing in anatomical position

Disadvantage

  • Can cause irritation; the tension band wire may need to be removed
ORIF - Lag screw
Main indication Skill Equipment
Unstable, large fragment Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Large-fragment ulnar styloid fractures
  • Widely displaced fracture
  • Unstable fracture
  • Comminuted fracture (relative indication)
  • Unstable distal radio ulnar joint

Contraindications

  • Local soft-tissue injuries
  • Poor condition of overlying soft-tissue envelope
  • Patient not fit for surgery

Advantages

  • No local irritation (compared to tension band)
  • Early mobilization
  • Healing in anatomical position

Disadvantage

  • Technically demanding
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources