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.
| Articulations | |
|---|---|
| Landmarks |
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| Ossification | Ossifies with the distal ulnar epiphysis, whose secondary centre appears at about 5-7 years and fuses at about 17-19 years; the styloid may also have its own small centre, and failure of fusion can mimic a fracture. |
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.
Find the head of the ulna on the little-finger side of the back of the wrist, then move to its back and inner edge to feel a small, pointed projection; this is the ulnar styloid. It is easiest to feel with the forearm turned palm up and ends about 1 cm higher than the radial styloid.
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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