Ulnar styloid fracture is a common occurrence, especially when a person falls on an outstretched hand. It often causes pain, swelling and difficulty in movement. Proper diagnosis and treatment is necessary to preserve the functioning of wrist joint. It is important to know the causes, symptoms, treatment and rehabilitation of ulnar styloid fracture.
About Ulnar Styloid
The two bones of forearm are radius and ulna. At the end of ulna bone called head of ulna, towards wrist, there is an elevated projection known as the styloid process. The ulnar styloid is an important supportive structure of the triangular fibrocartilage complex (TFCC). This triangular fibrocartilage complex lies on distal ulna and is attached by thick tissues to the base of the ulnar styloid and by thinner tissue to the edge of the radius just nearer to the radiocarpal articular surface. This is a major contributor for the stability of distal radio-ulnar joint (DRUJ) and wrist as well. Disruption of the triangular fibrocartilage complex causes instability and the ulnar styloid plays a very important role in this.
Anatomically, the wrist is a complex joint that involves distal end of radius, distal ulna, 8 carpal bones and proximal portion of 5 metacarpal bones. Fracture of the wrist may involve either of the two bones or combined fracture of the both the bones. Most common type of wrist fracture is distal radius fracture that is the end bone fracture of radius. This often involves the fracture of the end portion of ulna that is ulnar styloid and this is known as ulnar styloid fracture. Again on the basis of the part involved it may be of basal ulnar styloid fracture if the base is impacted or fracture of the tip of ulnar styloid. Amongst both, the tip fracture is more commonly observed and most common is small avulsion fractures of the tip of ulnar styloid.
Causes of Ulnar Styloid Fracture
- Ulnar styloid fracture often occurs in association with radius fracture.
- One of the commonest causes of ulnar styloid fracture is fall onto the outstretched arm.
- Other causes of ulnar styloid fracture include osteoporosis, which is a condition of weak and fragile bones. In this, even the slightest pressure or a relatively minor fall, can result in ulnar styloid fracture.
- Aging is yet another common cause of ulnar styloid fracture. In old age the bones become fragile and the muscles turn weak. Sometimes elderly are seen to fall even in standing position and the impact causes wrist fracture.
- Vehicular accidents or other kind of accidents with strong impact and fall from height may also cause ulnar styloid fracture or wrist fracture.
Symptoms of Ulnar Styloid Fracture
Ulnar styloid fracture, mainly affects the wrist. Some of the common symptoms of ulnar styloid fracture include the following,
- Immediate severe pain is the prime feature.
- Swelling around the wrist joint.
- Tenderness is noted, which means pain felt when the wrist is touched.
- As the ulnar styloid is injured, sometimes the patient is unable to move the wrist or hold any objects.
If there is displacement in ulnar styloid fracture, deformity is visible around the affected part. If there is a non-displaced fracture of ulnar styloid, no deformity is observed even if pain may persist. In some cases, it is observed that pain and other symptoms appear later in progress and that there are no immediate symptoms. Therefore nondisplaced ulnar styloid fracture can cause difficulty in making the correct diagnosis. Hence, in such cases, it is important to consider the history, fall, blow or accident carefully and study other symptoms of ulnar styloid fracture to confirm the condition.
Diagnosis of Ulnar Styloid Fracture
Diagnosis of ulnar styloid fracture is based on the investigations advised, as found appropriate. The necessary investigations are prompted after a thorough history taking, clinical examination, assessment of signs and symptoms indicating a possible fracture.
Plain X Ray of wrist joint is prime investigation for fracture. Though non displaced ulnar styloid fracture sometimes is not visible clearly and is hard to diagnose. Further advanced scans may be ordered, if required, depending on the history and clinical findings.
Treatment of Ulnar Styloid Fracture
Treatment of ulnar styloid fracture depends upon its association with distal radius fracture and triangular fibrocartilage complex tear. Association with distal radius fracture when radio ulnar joint is stable, seldom requires any independent treatment as it shows no impact on the anatomical, radiological or functional result. Treatment for distal radius fracture works for it. As per studies, even displaced fracture or not healed fracture of ulnar styloid that is nonunion in patients did not affect their prognosis.
When distal radio ulnar joint is unstable in a fracture, independent treatment is required. Therefore after evaluation of distal radio ulnar joint stability by a qualified medical person, decision is made whether ulnar styloid fracture needs treatment.
Depending upon the site, the treatment of ulnar styloid fracture, is planned.
Treatment for Avulsion Tip Ulnar Styloid Fracture
Treatment of ulnar styloid fracture, when the affected area is at the tip:
If lesser portion is fractured and there is no instability of distal radio ulnar joint then no treatment is needed. For minimally displaced ulnar styloid fracture, splint in supine position of forearm for 3 to 4 weeks is the first choice of treatment plan.
Treatment for Base Ulnar Styloid Fracture
In this type of fracture of ulnar styloid, there is disruption of ligaments and triangular fibrocartilage complex that leads to instability of distal radio ulnar joint. Treatment for ulnar styloid fracture of this type is-
- Close reduction and pinning or external fixation.
- Open reduction and internal fixation [ORIF] required if it is a displaced fracture.
Healing Time for Ulnar Styloid Fracture
The healing time for ulnar styloid fracture depends on the type of treatment done. In case of conservative treatment or non-surgical approach, usually for a non-displaced fracture, a cast is used to support the fractured bone. In this case, the ulnar styloid fracture may heal within 3 to 4 weeks, if the other health condition of the person is fine. Depending on other associated injuries of the wrist or wrist fracture, complete healing and recovery may around 6 weeks.
In cases, where surgical treatment is used to treat the ulnar styloid fracture, the healing time depends on the severity and complexities of the injury and the type of surgery. In most cases, healing time is around 4 to 6 weeks, which is again influenced by proper post-operative care and rehabilitation.
Rehabilitation of Ulnar Styloid Fracture
To regain the functional use of hand and wrist is the main objective of rehabilitation of ulnar styloid fracture. When the cast is taken off after surgical or nonsurgical procedure to treat the fracture, some pain and swelling may persist there. During cast, the wrist normally remains non-functional for a long period, which often results in slight weakness and discomfort after the cast is removed. Medicines or painkillers may be prescribed for this.
Here are few tips to combat this discomfort –
- Soaking hands and wrist in luke warm water helps in reduction of swelling pain as well as dry and flaky skin.
- Use of a good moisturizer and body oil can help to relieve discomfort, swelling and skin irritation
- Avoid lifting any heavy objects and jerky movements up to 1 month.
- Ice or cold gel packs on wrist also relieves pain and swelling.
- Elevation of hand also helps to lessen the swelling. The hand needs to be above the level of the heart so that gravity can help move the fluid back and help reduce the swelling.
- Retrograde massage is a technique in which, massage is done and pressure is given from finger tips to forearm. It manually pushes fluid back towards the heart, while stimulating the superficial lymphatic system which helps to trim off the swelling.
Rehab Exercises for Ulnar Styloid Fracture
Rehabilitation for ulnar styloid fracture is important to regain its original strength and functionality. To restore muscle strength, mobility and function patients are advised for rehab exercises. Initially, it is advised to perform exercises in supervision of doctor or therapist that are clinical. According to the healing and range of motion therapist may advise you to perform at home as well. Repeated load-bearing activities work to build stronger and denser bones.
Examples of Few Exercises Are-
Touch the tip of each finger with the thumb.
Stand in Prayer position that is with palms together and elbows out. Slowly lower down wrists until a stretch is felt. Hold it for 5 seconds and slowly return to starting position.
- Wrist Flexion and Extension Hand Flips Exercise for Ulnar Styloid Fracture: Place forearm on a table, extend hand and affected wrist beyond the table, palm down. Now move your hand upward and allow your hand to close into a fist, then lower your hand and allow your fingers to relax. Hold each position for about 5 seconds. Repeat 10 times.
- Hand Side To Side Movement Exercise for Ulnar Styloid Fracture: Hand out in front and palm down. Slowly bend wrist as far as it can from left side to right side and vice versa. Hold each position for about 5 seconds. Repeat 10 times.
- Wrist Open Stretch Exercise for Ulnar Styloid Fracture: Extend the arm with the affected wrist in front and point the fingers facing towards the floor. With the other hand, gently bend the wrist farther until you feel a stretch in the forearm. Hold the stretch for at least 15 to 30 seconds. Repeat 2 to 4 times.
- Wrist Fist Stretch Exercise for Ulnar Styloid Fracture: Same as above but this time make a fist whilst palm facing down. Bend the wrist fist facing down.
- Wrist Upwards Stretch Exercise for Ulnar Styloid Fracture: Extend the arm with the affected wrist in front and palm facing away from the body. Back bend the wrist, pointing hands up toward the ceiling. With other hand, slowly bend the wrist farther until you feel some stretch in the forearm. Hold the stretch for at least 15 to 30 seconds. Repeat 2 to 4 times.
- Finger Hook Movement: Place the unaffected hand on a table, palm up. Put the hand with the affected wrist on top and the other hand placed on table with fingers wrapping around the thumb of normal like making a fist. Now, gently open the joints of the hand with the affected wrist so that only the upper two joints of fingers are bent looking like a hook. Hold the position for about 6 seconds. Move back to your starting position, with fingers wrapped around the normal thumb. Repeat 10 times.
Further, as the condition improves additional strengthening exercises for the wrist may be introduced. Self-management approach to manage pain and discomfort with positive health behaviors are developed during rehab plan. It is important to follow up with the treating doctor and the physical therapist to ensure healthy recovery. Timely treatment and proper rehabilitation can help in complete recovery from ulnar styloid fracture.