How long should I wear a splint for a subtle acute non-displaced fracture of the ulnar styloid process?

Management of Acute Non-Displaced Ulnar Styloid Process Fracture

For a subtle acute non-displaced fracture of the ulnar styloid process, immobilization in a splint for 3-4 weeks is recommended. 1

Initial Management

• Non-displaced ulnar styloid fractures can be effectively managed with conservative treatment using splinting
• Splints are the optimal choice for acute injuries with anticipated swelling 1
• Active finger motion exercises should begin immediately following diagnosis to prevent stiffness 1

Duration of Immobilization

The recommended immobilization period is based on several considerations:

• Average immobilization duration for distal forearm fractures is approximately 3-4 weeks 1
• For ulnar styloid fractures specifically, immobilization typically ranges from 4-6 weeks depending on:
  • Location of fracture (base vs. tip)
  • Presence of associated injuries
  • Patient age and bone quality

Post-Immobilization Care

After the immobilization period:

1. Progressive range of motion exercises should be started 1
2. A directed home exercise program is an option 1
3. Gradual return to activities based on pain tolerance and functional recovery

Important Considerations

• Complications of excessive immobilization include chronic pain, joint stiffness, muscle atrophy, and complex regional pain syndrome 1
• Ice application during the first 3-5 days can provide symptomatic relief 1
• Vitamin C supplementation is suggested for prevention of disproportionate pain 2

Special Situations

• Displaced fractures or those with distal radioulnar joint (DRUJ) instability may require surgical intervention 3, 4
• Base fractures of the ulnar styloid have higher potential for DRUJ instability than tip fractures 3
• Recent evidence suggests that non-union of ulnar styloid fractures does not significantly affect functional outcomes in most cases 3, 4

Monitoring and Follow-up

• Follow-up radiographs at 3-4 weeks to assess healing
• If persistent pain or functional limitation occurs after the immobilization period, further evaluation may be necessary to rule out:
  • DRUJ instability
  • Triangular fibrocartilage complex (TFCC) injury
  • Delayed union or non-union

Remember that temporary DRUJ immobilization might allow triangular fibrocartilage complex (TFCC) recovery in cases with associated soft tissue injury 3.