Ulnar Styloid Fractures: Treatment of a Broken Wrist

Fractures of the wrist can involve several different bones that surround the joint. The most common type of wrist fracture is through the end of the radius bone of the forearm, called distal radius fractures. Distal radius fractures account for about one in six broken bones seen in emergency rooms.

About half of distal radius fractures occur in association with ulnar styloid fractures. The ulnar styloid is at the end of the other forearm bone, called the ulna. While distal radius fractures usually require casting or surgery, the ulnar styloid is seldom addressed in treatment.

Ulnar Styloid Fractures

Ulnar styloid fractures seldom require treatment when they occur in association with a distal radius fracture. The major exception is when the joint between these bones, the distal radioulnar joint (or DRUJ), is unstable. When the DRUJ is unstable, the ulnar styloid may require independent treatment.

However, most distal radius fractures with associated ulnar styloid fractures occur without DRUJ instability. A recent study evaluated patients who had distal radius fractures and found that their prognosis was not affected by the presence or absence of an ulnar styloid fracture.

Symptoms of distal radioulnar joint instability include severe wrist pain, swelling around the joint, and difficulty turning the palm up or down.

Non-Union of Ulnar Styloid Fractures

This study also found that even if the ulnar styloid fracture was out of position (displaced), or if the ulnar styloid fracture did not heal (nonunion), it did not affect the patient's prognosis. Again, this is all presuming that the DRUJ was stable.

The results of this study would imply that routine surgical treatment of an ulnar styloid fracture (when occurring with a distal radius fracture) is not necessary. However, your doctor should evaluate your DRUJ for instability, and if that's found to be the case, your ulnar styloid fracture may need to be treated.

The central symptom of an ulnar styloid fracture is pain on the inside of your wrist. Bruising, tenderness, and swelling may also occur. In severe cases, your wrist and hand may hang at a different angle than they usually do.

"Missed" Diagnoses

Because an ulnar styloid fracture does not alter the treatment of the wrist injury, in most circumstances, orthopedic surgeons often fail to acknowledge that there is a second fracture, other than the distal radius fracture.

This is a mistake most orthopedic surgeons learn to avoid, as it causes concern that patients may feel their full injury was "missed." Most experienced orthopedic surgeons are very careful to inform their patients about the presence of an ulnar styloid fracture and explain why it not being treated.

If you do see an injury, such as an ulnar styloid fracture, that was not discussed with you, don't be afraid to ask your doctor about it. Just understand that the injury was probably not missed.

In most cases, an ulnar styloid fracture neither requires specific care nor changes the course of treatment. Your doctor will instead be focused on treating the distal radius fracture which may require casting and/or surgery.

A Word From Verywell

Ulnar styloid fractures are commonly associated with distal radius fractures; in fact, about half of distal radius fractures have an associated ulnar styloid fracture. The good news is that seldom does an ulnar styloid fracture require treatment in and of itself. Rather, the treatment decision is based on the injury to the radius bone and is not impacted by the presence of the injury to the ulnar styloid.