From the Guidelines
The management of ulnar styloid fractures should prioritize conservative treatment for stable, non-displaced fractures, while displaced fractures or those with distal radioulnar joint instability may require surgical intervention. When considering the management of ulnar styloid fractures, it's crucial to assess the fracture's stability, displacement, and any associated injuries. For stable, non-displaced ulnar styloid fractures, conservative treatment is usually recommended, consisting of immobilization with a short arm cast or splint for 4-6 weeks, followed by progressive range of motion exercises, as seen in general fracture management principles 1. Pain management includes NSAIDs such as ibuprofen 400-600mg three times daily or naproxen 500mg twice daily, along with acetaminophen 650mg every 6 hours as needed. However, displaced fractures, especially those with distal radioulnar joint (DRUJ) instability, may require surgical fixation with tension band wiring, screw fixation, or excision of the fragment, highlighting the importance of individualized treatment plans based on fracture characteristics and patient needs. Some key points to consider in the management of ulnar styloid fractures include:
- Immobilization for 4-6 weeks for non-displaced fractures
- Surgical intervention for displaced fractures or those with DRUJ instability
- Pain management with NSAIDs and acetaminophen
- Regular follow-up with radiographic assessment to monitor healing and detect complications. Given the potential for complications such as nonunion or DRUJ instability, which can lead to chronic wrist pain and limited function if not properly addressed, careful consideration of the treatment approach is necessary, although the provided evidence does not directly address ulnar styloid fractures, general principles of fracture management can be applied 1.
From the Research
Management of Ulnar Styloid Fracture
- The management of ulnar styloid fracture can be either non-operative or operative, depending on the severity of the fracture and the presence of distal radioulnar joint (DRUJ) instability 2, 3.
- Non-operative treatment is often preferred for stable fractures, while operative treatment may be considered for fractures with malalignment or instability 3.
- A study comparing operative and non-operative treatment of ulnar styloid base fractures found that non-surgically treated patients had better wrist function at 6 months, but there was no observed difference after 12 months 2.
- However, another study found that ulnar styloid nonunion usually does not cause any problems on the wrist, and surgical approaches may not be indicated for ulnar styloid fractures 3.
Surgical Management
- For symptomatic ulnar styloid fractures with small bony avulsion, anchor suture fixation and tension band wire fixation are two possible surgical options 4.
- A study comparing these two methods found that anchor suture fixation is a feasible option for tiny styloid avulsion fragments with limited surgical complication, and yields comparable treatment outcomes to tension band wire fixation 4.
- Arthroscopic suture of triangular fibrocartilage complex (TFCC) or suture TFCC combined with internal fixation treatment are also beneficial for wrist function recovery in ulnar styloid base fractures with TFCC injury 5.
Treatment Outcomes
- The effectiveness of treatment for ulnar styloid fracture can be evaluated using various outcome measures, including the modified Gartland-Werley score, Mayo Modified Wrist Score (MMWS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and visual analog scale (VAS) 5, 4.
- A study found that the excellent and good rates according to the modified Gartland-Werley score were higher in the arthroscopic suture of TFCC group and the combination group compared to the internal fixation group 5.
- Another study found that outcome assessment regarding MMWS, QuickDASH, and VAS was comparable between anchor suture fixation and tension band wire fixation groups 4.