From the Guidelines
Initial management of an ulnar styloid process fracture in an urgent care setting involves immobilization with a short-arm cast or a volar splint for 3-4 weeks. Pain control should be addressed with NSAIDs such as ibuprofen 400-600mg every 6 hours or naproxen 500mg twice daily, with acetaminophen 650mg every 6 hours as an alternative or supplement. Ice should be applied for 15-20 minutes every 2-3 hours for the first 48-72 hours to reduce swelling and pain. The wrist should be elevated above heart level when possible. Most ulnar styloid fractures are stable and heal well with conservative management, especially if non-displaced, as there is no strong evidence to support fixation of ulnar styloid fractures associated with distal radius fractures, as noted in a study published in The Journal of the American Academy of Orthopaedic Surgeons 1. Patients should be referred to orthopedics or hand surgery for follow-up within 1-2 weeks, particularly if the fracture is displaced more than 2mm or if there is concern for distal radioulnar joint instability. Some key points to consider in management include:
- Immobilization to promote healing
- Pain management to improve patient comfort
- Monitoring for complications such as compartment syndrome Patients should be instructed to return to urgent care if they experience increasing pain, numbness, tingling, color changes in fingers, or inability to move digits, as these may indicate compartment syndrome or other complications requiring immediate attention.
From the Research
Initial Management of Ulnar Styloid Process Fracture in UC
- The initial management of a styloid process of ulna fracture in an urgent care (UC) setting is crucial for optimal outcomes.
- According to 2, non-surgically treated patients had better wrist function at 6 months, and there was no observed difference after 12 months.
- However, fewer patients had ulnar styloid non-unions in the operative group, and more patients suffered complications in the operative group.
Treatment Options
- The treatment options for ulnar styloid process fractures include conservative management and surgical fixation, as stated in 2.
- Surgical fixation may be considered in selective cases, such as persistent distal radioulnar joint (DRUJ) instability during ballottement test after fixation of the radius, as mentioned in 2.
- Different surgical techniques, such as tension band wiring, anchor suture fixation, and K-wire fixation, have been compared in terms of their effectiveness, as discussed in 3 and 4.
Timing of Intervention
- The timing of surgical intervention is also an important factor, as early fixation of ulnar styloid base fractures yields different outcomes compared to late fixation, as reported in 5.
- Early detection and surgical repair may yield better outcomes, with significantly better QuickDASH scores, grip strength, and range of motion, as found in 5.
Conservative Management
- In some cases, unrepaired fracture of the styloid process of the ulna may not have a significant effect on radiological and functional results, as stated in 6.
- The repair of a fracture of the styloid process of the ulna may not be necessary if reduction and fixation of the distal radius fracture is anatomical and stable, as mentioned in 6.