What type of splint is recommended for a nondisplaced ulnar styloid fracture?

Splinting for Nondisplaced Ulnar Styloid Fractures

For nondisplaced ulnar styloid fractures, a removable splint is the recommended treatment option, providing adequate immobilization while allowing for better comfort and function compared to rigid casting.

Treatment Rationale

The American Academy of Orthopaedic Surgeons (AAOS) guidelines provide specific recommendations that can be applied to ulnar styloid fractures:

1. For minimally displaced fractures, removable splints are an appropriate treatment option 1. This recommendation is supported by evidence showing that removable splints provide adequate immobilization while allowing for better comfort.

2. In contrast, rigid immobilization (casting) is suggested for displaced fractures 1. Since we're specifically addressing nondisplaced ulnar styloid fractures, rigid casting would be unnecessary.

Splint Type and Application

Recommended Splint:

• Posterior splint (back-slab) is the preferred option for nondisplaced ulnar styloid fractures
• Studies have shown better pain relief within the first 2 weeks of injury with posterior splinting compared to other immobilization methods 1

Application Details:

• The splint should immobilize the wrist while allowing finger mobility
• Position should maintain neutral alignment of the wrist
• Splint should extend from mid-forearm to just proximal to the metacarpophalangeal joints

Duration of Immobilization

• Typically 3-4 weeks for nondisplaced ulnar styloid fractures
• Follow-up radiographs should be obtained at approximately 3 weeks to assess healing 1
• If radiographs show adequate healing, the splint can be discontinued

Follow-up Care

• Active finger exercises should begin immediately to prevent stiffness
• After splint removal, gradual return to activities with progressive strengthening exercises
• Monitor for potential complications such as:
  • Persistent pain (may indicate nonunion)
  • Distal radioulnar joint instability
  • Sensory changes (could indicate ulnar nerve irritation)

Important Considerations

When Surgery May Be Indicated

While nondisplaced fractures generally do well with splinting, certain situations may warrant surgical consideration:

• Distal radioulnar joint instability
• Large, displaced fragments involving the fovea (attachment site of the triangular fibrocartilage complex)
• Symptomatic nonunion after conservative treatment 2

Common Pitfalls to Avoid

1. Overlooking associated injuries: Ulnar styloid fractures often occur with distal radius fractures, which may require different management
2. Inadequate follow-up: Failure to monitor for healing may miss development of nonunion
3. Prolonged immobilization: Can lead to stiffness and delayed functional recovery
4. Ignoring symptoms of nerve injury: Ulnar styloid fractures can occasionally be associated with dorsal branch ulnar nerve injury 3

Evidence Quality Assessment

The evidence supporting removable splinting for nondisplaced ulnar styloid fractures comes primarily from AAOS guidelines on distal radius fractures 1. While these guidelines don't specifically focus on isolated ulnar styloid fractures, the principles of treatment for minimally displaced fractures can be reasonably applied.

Research by Souer et al. 4 found that in patients with a stable distal radioulnar joint after distal radius fracture fixation, the presence of an ulnar styloid fracture did not affect subjective outcomes, supporting a conservative approach to nondisplaced ulnar styloid fractures.