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DR.JAMAL AL-SAIDY
M.B.CH.B…F.I.C.M.S
FRACTURED RADIAL STYLOID
This injury is caused by forced radial deviation of the wrist and may occur after a fall, or
when a starting handle ‘kicks back’ – the so-called ‘chauffeur’s fracture‘.
The fracture line is transverse, extending laterally from the articular surface of the radius;
the fragment, much more than the radial styloid, is often undisplaced. The radial styloid
can also be fractured as part of the far more serious trans-scaphoid perilunate fracture
dislocation.
Treatment
If there is displacement it is reduced, and the wrist is held in ulnar deviation by a plaster
slab round the outer forearm extending from below the elbow to the metacarpal necks.
Imperfect reduction may lead to osteoarthritis; therefore if closed reduction is imperfect
the fragment should be screwed back, or held with K-wires.
ULNAR-SIDE WRIST INJURIES
The distal radio-ulnar joint is often injured with a radial fracture; it can also be damaged
in isolation, particularly after hyperpronation.
The triangular fibrocartilage complex (TFCC) can be torn, the ulnar styloid avulsed or
the articular surfaces of the ulnocarpal joint or distal radio-ulnar joint damaged.
Clinical features
There is tenderness over the distal radio-ulnar joint and pain on rotation of the forearm.
The distal ulna may be unstable; the piano-key sign is elicited by holding the patient’s
forearm pronated and pushing sharply forwards on the head of the ulna.
Imaging and arthroscopy
A lateral x-ray in pronation and supination shows incongruity of the distal radio-ulnar
joint.
The anteroposterior view may show an avulsed ulnar styloid.
Arthrography, MRI and arthroscopy may be needed to confirm the diagnosis.
Treatment
Instability usually resolves if the arm is held in supination for 6 weeks; occasionally a K-
wire is needed to maintain the reduction.
If the dislocation is irreducible, this may be due to trapped soft tissue, which will have to
be removed.
Chronic instability may require reconstructive surgery.
THANK YOU
DR.JAMAL AL-SAIDY
M.B.CH.B..…… F.I.C.M.S