A 53-Year-Old Male with Wrist Pain After a Fall

Differential Diagnosis

• Carpal-metacarpal dislocation
• Distal radius fracture
• Extensor carpi ulnaris subluxation
• Scaphoid fracture
• Ulnar styloid fracture

Diagnosis

This patient was diagnosed with a fracture of the ulnar styloid. Note there is a break in the cortex, displacement of the fracture fragment, and loss of alignment of the trabeculations.

Learnings/What to Look For

• While approximately 50% of patients with distal radial fractures will have associated ulnar styloid fracture, ulnar styloid fractures can occur as isolated injuries (as in this case)
• Most fractures are small avulsions at the tip, occasionally involving the body or base of the styloid
• Fractures through the base of the styloid can lead to instability of the distal radioulnar joint and injury to the triangular fibrocartilage complex
• Accessory ossicles can appear similar to styloid avulsions

Pearls for Urgent Care Management and Considerations for Transfer

• With evidence of an isolated ulnar styloid fracture, search for a distal radius fracture or a carpal fracture or dislocation
• If the neurovascular status is intact, the patient may be placed in an ulnar gutter or volar splint with recommendations
• Indications for transfer include intractable pain, consideration of vascular injury, compartment syndrome, or associated displaced fracture or dislocation

Acknowledgment: Images and case presented by Experity Teleradiology (www.experityhealth.com/teleradiology).