Treatment of Non-Displaced Radial Styloid Fracture with Intraarticular Extension
For a non-displaced radial styloid fracture with intraarticular extension, conservative management with removable splinting is appropriate, provided there is no significant displacement (>3mm) or dorsal tilt (>10°), combined with immediate active finger motion exercises to prevent stiffness. 1
Initial Assessment and Treatment Decision
The key determinant is whether the fracture meets criteria for "non-displaced":
- Measure displacement carefully: If intraarticular displacement is >3mm, dorsal tilt is >10°, or radial shortening is >3mm, surgical fixation is indicated rather than conservative management 1
- For truly non-displaced fractures: Removable splints are an acceptable treatment option per AAOS guidelines 1
- Intraarticular involvement alone does not mandate surgery if displacement criteria are not met 1
Conservative Management Protocol
When conservative treatment is appropriate:
- Use a removable splint rather than rigid casting for patient comfort and to facilitate early motion 1
- Initiate active finger motion exercises immediately following diagnosis—this is critical as stiffness is one of the most functionally disabling complications of distal radius fractures 1
- Finger motion does not adversely affect adequately stabilized distal radius fractures in terms of reduction or healing 1
- Early wrist motion is not routinely necessary following stable fracture fixation 1
Follow-Up and Monitoring
- Obtain radiographic follow-up at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 1
- Monitor for complications including skin irritation and muscle atrophy, which occur in approximately 14.7% of immobilization cases 1
- Watch for loss of reduction: If follow-up imaging shows development of significant displacement, conversion to surgical management may be necessary 1
When to Convert to Surgical Management
Surgical fixation becomes necessary if:
- Post-reduction or follow-up imaging shows radial shortening >3mm, dorsal tilt >10°, or intraarticular displacement >3mm 1
- The fracture pattern is actually displaced on careful review—radial styloid fractures can be associated with complex injury patterns that require operative treatment 2
- Persistent nerve dysfunction develops after reduction, which may require nerve decompression 1
Common Pitfalls to Avoid
- Do not rely solely on initial plain radiographs if there is any uncertainty about displacement—consider CT imaging to accurately assess intraarticular extension and displacement, as recommended for complex articular injuries 3
- Avoid prolonged immobilization without finger motion, as this increases stiffness risk without improving outcomes 1, 4
- Do not underestimate the importance of precise reduction in intraarticular fractures—even small step-offs or gaps are associated with development of radiocarpal osteoarthritis 5