Wrist Fractures: Fixation of Radial Styloid Process Fractures With a Plate

Wrist Fractures: Fixation of Radial Styloid Process Fractures With a Plate

This video will provide a surgical demonstration for treating a type of wrist fracture, called a radial styloid process fracture, utilizing a plate and screws. The procedure will be demonstrated on a cadaveric specimen. 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.

The radial styloid process is a bony projection at the end of the radius that may be fractured during a wrist injury. Given its role in the overall alignment of the wrist joint, it is important to restore its position if a fracture disrupts its alignment. Here is a right hand. An incision will be made overlying the thumb side of the wrist. The surgeon dissects down to the radial styloid process, mindful of important tendons and nerves that cross the wrist joint.

A temporary wire will be passed through the radial styloid process to hold the alignment of the bone as well as plan for the optimal position of the plate. An x-ray will be taken to confirm the wire is centered in the bone. The plate will then be introduced over the wire and onto the radial styloid process. Another temporary wire with a ball-tip will be placed in the plate to further hold its position to the bone. X-rays will continue to be taken to confirm the placement of the plate prior to placing the screws. There is no fracture seen on this x-ray given the cadaver's normal anatomy.

The first screw will be placed in the oblong hole. A drill and drill guide will make a hole in the bone which will be measured prior to placing the screw. The additional screw holes will be drilled, and different screws, called locking screws, will be used. These screws have threads that engage with the threads in the plate. By locking into the plate, they can provide more stability and less movement. The surgeon is shown placing the final locking screw in the plate.

Final x-rays are taken. Screws are shown nicely supporting the joint surface at the radial styloid, and the remaining plate and screws are shown in proper position. The incision will be closed, and the surgery is now complete.