Wrist Fractures: Fixation With Ulnar Styloid Plating

Wrist Fractures: Fixation With Ulnar Styloid Plating

This cadaveric surgical video will demonstrate how to treat a wrist fracture utilizing an ulnar styloid plate. The wrist joint comprises the ends of 2 bones in the forearm, called the radius and ulna, and a row of small bones called carpal bones. Wrist fractures most commonly impact the end of the radius and are referred to as distal radius fractures. Often, the end of the ulna bone will also be fractured when the radius is injured.

In cases where the tip of the ulna is fractured, also called the ulnar styloid fracture, and the joint is unstable between the ulna and radius, a plate will be needed to stabilize the injury. Here is a left hand. A surgical incision is made to the pinky side of the wrist, overlying the ulna. The surgeon carefully exposes the ulna bone, mindful of nearby nerves. Here is the ulnar styloid. The plate will be introduced over the end of the ulna. An x-ray shows the plate’s prongs contouring over the ulnar styloid.

A temporary ball-tipped wire is used to hold the plate to the bone. There is no fracture seen on this x-ray given the cadaver's normal anatomy. A drill guide and drill will be used to make a hole in the bone for the first screw. The hole will be measured, and the proper-sized screw is placed. Then a different type of drill guide is used for a type of screw called a locking screw. These screws have threads that engage with the threads in the plate, which provides more stability, preventing movement.

Once the hole is drilled, the locking screw will be placed. Additional locking screws will be placed in the same manner in additional holes depending on the injury and surgeon preference. X-rays will continue to be taken to confirm placement of the screws. The surgeon is mindful to protect the joint that lies between the ulna and radius and ensures that the screws do not extend into this area. A final screw can be placed between the hooks of the plate if needed. The surgical incision will be closed in a layered approach and the surgery is now complete.