Management of Ulnar Styloid Nonunions

Ulnar styloid fractures commonly occur in conjunction with distal radius fractures but can also occur in isolation. Displaced basilar styloid fractures that involve the attachment of the liga-mentum subcruentum may be associated with DRUJ instability. However, a large majority of proximal fractures involving the base of the ulnar styloid can progress to an asymptomatic nonunion. Various clinical series have reported minimal to no effect of ulnar styloid nonunion on strength, motion, or functional outcomes in the setting of a healed distal radius fracture. When an ulnar styloid nonunion remains symptomatic or causes persistent DRUJ instability, surgical intervention is warranted. Preoperative advanced imaging and/or diagnostic wrist arthroscopy can provide critical information when considering TFCC repair. Treatment options include: (1) ulnar styloid fragment excision for painful impinge-ment; (2) ulnar styloid fragment excision and TFCC repair for DRUJ instability in the setting of a small styloid tip not amenable for repair; and (3) ulnar styloid fragment ORIF f TFCC repair for large fragments. During ulnar styloid nonunion repair, rigid fixation can be accomplished with several implant options, selected based on frac-ture pattern and location.