Alternative Methods of Management

Nondisplaced radial styloid fractures or reducible fractures without significant greater or lesser arc injuries can be treated with cast immobilization. Fractures that are significantly displaced at the time of presentation are unstable and

RADIAL STYLOID FRACTURES | Table 59-1 Alternative Methods of Management

Type of Management Indication

Contraindications

Comments

Nonoperative Articular offset or gap less than

1 mm

Coexisting displaced carpal fracture or ligament disruption

Advantage of eliminating joint contracture from scar

Operative (closed reduction and pinning)

Articular offset or gap greater than 1 mm, coexisting carpal or ligament injury

Irreducible displaced carpal fractures and ligament injuries

Ideal adjunct for arthroscopically assisted reduction procedures

Operative (arthrotomy) Irreducible styloid, carpal fractures, and ligament disruptions

None when closed or percutaneous treatment is adequate

Allows internal fixation placement under direct vision and ligament augmentation/ reconstruction in select cases

Operative (external fixation)

Markedly comminuted Styloid fractures suitable for scaphoid facet fractures Kirschner wire or screw fixation

Capsuloligamentotaxis unloads scaphoid facet should be pinned. Small styloid tip avulsion fractures may appear as benign injuries but may harbinger subtle important carpal or intercarpal pathology (Table

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