The ulnar styloid is a conical bony projection from the posteromedial aspect of the distal ulna. The apex of the styloid is the attachment of the triangular fibrocartilage complex (TFCC), and the base of the styloid is the attachment of the ulnocarpal ligaments. It is palpable on the medial dorsal wrist and forms the medial boundary of the distal radioulnar joint.
Ulnar styloid fractures occur in approximately 60% of distal radius fractures. A basal styloid fracture with fragment displacement greater than 2 mm or associated TFCC avulsion has clinical significance: it can cause DRUJ instability that requires fixation. Isolated tip fractures are usually managed conservatively. Ulnar styloid impaction syndrome involves contact between a long ulnar styloid and the triquetrum during ulnar deviation, producing ulnar-sided wrist pain.
A basal ulnar styloid fracture associated with a displaced distal radius fracture can represent avulsion of the TFCC, creating DRUJ instability that requires styloid fixation or direct TFCC repair to restore forearm rotation stability.
An abnormally long ulnar styloid repeatedly contacts the triquetrum during ulnar deviation, producing ulnar-sided wrist pain and chondral damage, managed with activity modification, splinting, or surgical styloid shortening.
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