From the Guidelines
Surgical intervention for a distal radial styloid fracture is indicated when the fracture is unstable, significantly displaced, or involves the articular surface with more than 2mm of step-off, as evidenced by the most recent and highest quality study 1.
Key Indications for Surgery
- Unstable or significantly displaced fractures
- Fractures involving the articular surface with more than 2mm of step-off
- Fractures with more than 10 degrees of dorsal angulation
- Fractures with more than 2mm of radial shortening
- Fractures extending into the radiocarpal or distal radioulnar joint
- Open fractures
- Fractures with associated neurovascular compromise
- Fractures that fail closed reduction attempts
Surgical Approach
The specific surgical approach depends on fracture characteristics, with options including:
- Percutaneous pinning
- External fixation
- Open reduction and internal fixation with plates and screws
Goal of Surgical Treatment
The goal of surgical treatment is to:
- Restore anatomical alignment
- Maintain joint congruity
- Allow for early mobilization to prevent stiffness
- Prevent long-term complications such as malunion, post-traumatic arthritis, and functional limitations that can occur with non-anatomic healing of these fractures, as supported by 1 and 1.
Post-Operative Management
Post-operative management typically involves:
- Immobilization for 2-6 weeks depending on fracture stability and fixation method
- Progressive rehabilitation focusing on range of motion exercises and gradual strengthening, with the most recent guidelines provided by 1.
From the Research
Indications for Surgical Intervention
Surgical intervention for a distal radial styloid fracture is considered in certain cases, including:
- When the fracture is unstable or displaced, and closed reduction is not possible or has failed 2
- When there are associated injuries, such as carpal fractures or dislocations, that require surgical treatment 2
- When the fracture pattern is complex, and fragment-specific fixation is necessary to achieve accurate articular reconstruction and minimal hardware irritation 3
- In elderly patients with concurrent ulnar styloid fractures, where surgical intervention may be beneficial for optimal long-term functional recovery 4
Fracture Patterns and Treatment
The treatment of distal radial styloid fractures depends on the fracture pattern and the presence of associated injuries. Some common fracture patterns and their treatment include:
- Radial styloid fractures that occur in isolation or in association with other injuries, such as complex intra-articular distal radius fractures, carpal fractures, carpal dislocations, and radiocarpal dislocations 2
- Unstable distal radial fractures that require open reduction and internal fixation or closed reduction and percutaneous fixation 5
- Ulnar styloid fractures that occur in association with distal radial fractures, where the treatment of the ulnar styloid fracture may not be necessary if the distal radial fracture is stable 6
Outcomes and Complications
The outcomes and complications of surgical intervention for distal radial styloid fractures depend on various factors, including:
- The accuracy of the reconstruction and the magnitude of the injury, with better results associated with lower-energy patterns 2
- The presence of associated injuries, such as carpal fractures or dislocations, which can affect the outcome and increase the risk of complications 2
- The type of fixation used, with fragment-specific fixation potentially offering advantages in terms of accurate articular reconstruction and minimal hardware irritation 3