Wrist Case 3 ED Management

Ulnar Styloid Fractures

Type I (distal) fractures with stable DRUJ can be placed in an ulnar gutter splint with the wrist in neutral position with slight ulnar deviation, with routine referral to a hand specialist. These fractures occasionally result in painful malunion requiring arthroscopic excision of the fracture fragment.

Type II fractures with no evidence of DRUJ instability may also be splinted and referred, provided that follow-up will be reliable. Type II (proximal) fractures with DRUJ instability will require surgical fixation (either closed by K-wire if isolated or by ORIF if associated with distal radius fracture).