Treatment of Radial Styloid Nondisplaced Fracture
A nondisplaced radial styloid fracture should be treated with short-arm cast immobilization for 3 weeks, followed by immediate active finger motion exercises.
Initial Management
Immobilize with a short-arm cast for 3 weeks rather than the traditional 5-6 weeks. 1 A randomized controlled trial demonstrated that 3 weeks of immobilization resulted in significantly better patient-reported outcomes (PRWE scores: 5.0 vs 8.8 points, p=0.045; QuickDASH scores: 0.0 vs 12.5, p=0.026) compared to 5 weeks, with no increase in complications including secondary displacement. 1
- For minimally displaced fractures (defined as <3mm displacement, dorsal angulation <15°, volar tilt <20°, radial inclination >15°, ulnar positive variance <5mm, and articular step-off <2mm), cast immobilization is the appropriate treatment. 2, 3
- A sugar-tong splint may be used initially, followed by conversion to a short-arm cast. 2
Immediate Rehabilitation Protocol
Begin active finger motion exercises immediately upon diagnosis to prevent stiffness, which is one of the most functionally disabling complications of distal radius fractures. 4, 5 Finger motion does not adversely affect adequately stabilized fractures. 4
Adjunctive Treatments
- Apply ice at 3 and 5 days post-injury for symptomatic relief, as recommended by the American Academy of Orthopaedic Surgeons. 6, 4
- Consider low-intensity ultrasound for short-term improvement in pain and radiographic union, though long-term benefits remain unproven. 6, 4
- Consider vitamin C supplementation for prevention of disproportionate pain (moderate strength recommendation). 6
Follow-Up Protocol
- Obtain radiographic follow-up at 3 weeks to assess healing and rule out secondary displacement. 4, 5
- Repeat radiographs at cast removal (3 weeks) to confirm adequate healing. 4, 5
- Remove cast at 3 weeks if healing is progressing appropriately. 1
Critical Caveats
Assess for median nerve injury at initial presentation, as distal radius fractures may be complicated by nerve compression. 2 Check for paresthesias in the thumb, index, and middle fingers.
Monitor heavy smokers more vigilantly, as tobacco use significantly impairs bone healing and increases nonunion risk even in nondisplaced fractures. 7 Offer smoking cessation counseling at presentation. 7
If an associated ulnar styloid fracture is present, it typically does not require separate fixation, as studies show no significant difference in outcomes between treatment and non-treatment when the radius fracture is properly managed. 6, 5
When Conservative Treatment Fails
If the fracture fails to unite after appropriate immobilization (particularly in heavy smokers or high-demand athletes), surgical options include resection of the distal bone fragment, which allows return to activity within 2-3 months postoperatively. 8