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Understanding Ulnar Styloid Fractures: Key Insights into Wrist Injuries

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Understanding Ulnar Styloid Fractures: Key Insights into Wrist Injuries

Ulnar styloid fractures, ulnar, and distal ulnar fractures are some of the most common injuries in the wrist area. These types of forearm fractures often accompany distal radius fractures, impacting the ulnar styloid process in 80% of intra-articular distal radial injuries (1). Often leading to complications in wrist movement. In this article, we will explore the nature of ulnar styloid fractures, discuss their diagnosis, treatment, and management options, and highlight the crucial role of the ulnar styloid process in wrist stability. 


1. What Is an Ulnar Styloid Fracture?

An ulnar styloid fracture occurs when the styloid process of the ulna, a small bony projection at the end of the ulna near the wrist, breaks due to trauma. These commonly are fractures associated with distal radius fractures. In many cases, the fracture occurs at the base of the styloid. Ulnar styloid fractures can result from a fall on an outstretched hand, a direct blow to the wrist, or twisting injuries during activities like sports or manual labour. In some instances, the fracture of the ulnar styloid may occur in isolation, but this is less common.

2. Why Does the Ulnar Styloid Process Matter?

The ulnar styloid process plays a critical role in the stability of the distal radioulnar joint (DRUJ), which is essential for the wrist’s rotational movements. The DRUJ allows for the twisting motion of the forearm (pronation and supination), making it essential for daily activities such as turning a doorknob or using a screwdriver. An injury to the ulnar styloid process can lead to distal radioulnar joint instability, compromising function.

The ulnar styloid process also serves as an attachment point for ligaments that support joint stability. Therefore, when this structure is damaged, it can lead to ongoing instability and ulnar-sided pain, especially if not treated properly.

3. Common Symptoms of Ulnar Styloid Fractures

The most notable symptom of an ulnar styloid fracture is sharp pain, typically felt on the ulnar side or the “outside” of the wrist. Patients may also experience swelling, bruising, and tenderness over the ulnar styloid area. Additionally, mobility is often compromised, with pain intensifying during specific movements, particularly those involving twisting or gripping.

Unlike distal radial fractures, ulnar styloid fractures may not always present with an obvious deformity, but is consistently associated with ulnar sided wrist pain . Persistent pain and difficulty in rotating the wrist are strong indicators of an ulnar styloid injury.

4. How Are Ulnar Styloid Fractures Diagnosed?

Diagnosing an ulnar styloid fracture begins with a thorough physical examination, during which on of our specialist hand therapists, assesses the location of the pain, swelling, and deformity. Imaging tests such as X-rays are crucial in confirming the fracture and determining whether it is accompanied by a distal radius fracture. X-rays can reveal the location of the fracture within the ulnar styloid process and assess if the distal radioulnar joint is affected.

In complex cases, MRI scans may be required to better visualise soft tissue damage, such as ligament tears, which often accompany ulnar styloid fractures. These imaging techniques allow doctors to accurately plan the most effective treatment.

What other types of fractures can occur in the ulna and radius?

  1. Ulnar head fractures. This type of fracture happens at the elbow end of the ulna and is the least common ulna fracture. 
  2. Ulnar shaft fractures (or “Nightstick” fractures). This fracture type is usually associated with direct blows to the forearms, usually when someone is defending themselves from attack. 

5. Distal Ulnar Fractures: Are They Different?

A distal ulnar fracture is a break in the distal end of the ulna, which is closer to the wrist joint. This type of fracture may or may not involve the ulnar styloid process but generally affects the stability of the wrist. Distal ulnar fractures are less common than fractures of the distal radius but often occur in conjunction with them.

Distal ulna fractures require careful attention because of their potential to cause instability in the distal radioulnar joint. Treatment for a distal ulna fracture can vary depending on the severity but generally involves stabilisation to ensure proper healing and joint function.

6. What Are the Treatment Options for Ulnar Styloid Fractures?

Treatment for ulnar styloid fractures depends on the severity of the break and the stability of the distal radioulnar joint. Minor fractures can often be managed non-surgically with splints, casts, and rest. It is advised to see a specialist hand therapist, like our experts, to assess you and to help you draw up a plan to restore strength and range of motion in the wrist.

For more severe fractures, especially those involving distal radioulnar joint instability, surgical intervention may be required. Fixation techniques such as open reduction and internal fixation (ORIF) are commonly used to stabilise the fracture and promote healing. The goal of treatment is to restore function and prevent long-term complications such as chronic pain or instability.

7. Can Ulnar Styloid Fractures Lead to Complications?

One potential complication of ulnar styloid fractures is nonunion, where the bone fails to heal properly. Ulnar styloid nonunion can result in chronic ulnar-sided wrist pain and may require additional surgery to correct. Another complication is distal radioulnar joint instability, which can lead to decreased function and ongoing pain.

When left untreated or improperly managed, ulnar styloid fractures may lead to long-term issues such as stiffness, weakness, and a reduced range of motion, particularly during tasks that require forearm rotation.

8. The Role of Fixation in Ulnar Styloid Fractures

In cases where the ulnar styloid fracture is displaced or associated with instability of the distal radioulnar joint, internal fixation becomes essential. Internal fixation involves the use of screws, plates, or wires to hold the fractured bone fragments together while they heal. This approach is often necessary for fractures at the base of the ulnar styloid, where ligament attachment plays a significant role in wrist stability.

Fixation procedures have been shown to improve outcomes in cases of unstable distal ulnar fractures, allowing for a faster recovery and minimising long-term complications. However, not all fractures require fixation, and the decision is typically based on the extent of joint instability.

9. How Do Ulnar Styloid Fractures Influence Wrist Function?

Ulnar styloid fractures can significantly impact hand function, particularly if not treated properly. The fracture can affect the stability of the distal radioulnar joint, leading to difficulty in performing everyday tasks that involve rotation. Patients often report a decrease in wrist strength and mobility, with symptoms persisting even after the bone has healed.

Long-term consequences of untreated or improperly treated ulnar styloid fractures can include chronic pain, limited range of motion, and weakness, making it difficult to carry out activities that require gripping or twisting motions.

10. Managing Ulnar Styloid Fractures: A Review of the Literature

The management of ulnar styloid fractures has evolved significantly, with the latest literature emphasising the importance of early diagnosis and appropriate treatment. Studies suggest that while many ulnar styloid fractures can heal without surgery (2), those associated with distal radioulnar joint instability may require more aggressive earlier intervention, including fixation for better results when surgery is indicated (3). 


Key Takeaways:

  • Ulnar styloid fractures often accompany distal radius fractures and can compromise wrist stability.
  • The ulnar styloid process is crucial for the stability of the distal radioulnar joint.
  • Symptoms include ulnar-sided wrist pain, swelling, and limited mobility.
  • Diagnosis involves physical examination and imaging, with treatment options ranging from conservative methods to surgical fixation.
  • Early treatment of ulnar styloid fractures is essential to prevent complications such as non-union or chronic wrist pain.
  • Fixation may be necessary in cases of joint instability to restore function and improve outcomes.

Understanding the implications of an ulnar styloid fracture and its treatment can make a significant difference in the recovery and long-term health of the wrist. If you want some help with your recovery from an Ulna Styloid Fracture – or any other type of hand a wrist fracture then contact our expert hand therapy team to make an appointment.

References:

Chen, A.CY., Chiu, CH., Weng, CJ. et al. Early and late fixation of ulnar styloid base fractures yields different outcomes. J Orthop Surg Res 13, 193 (2018). https://doi.org/10.1186/s13018-018-0899-6

Fish MJ, Palazzo M. Distal Ulnar Fractures. [Updated 2023 Nov 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK580565/

van Rossenberg, L.X., Beeres, F.J.P., van Heijl, M. et al. Operative versus non-operative treatment of ulnar styloid process base fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg (2024). https://doi.org/10.1007/s00068-024-02660-2

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