Ulnar Styloid and Toe Fractures: Recovery and Treatment Insights

Ulnar styloid prominence and toe fractures?

Hello Doctor: I am a 22-year-old male.
On May 12, I had a car accident where I fell and braced myself with my hands, resulting in an ulnar styloid fracture of my right wrist and a proximal phalanx fracture of my right big toe.
X-rays confirmed that there was no significant displacement.
On the same day, I received emergency treatment and was placed in a cast for five days.
On May 17, during a follow-up visit to the orthopedic clinic, the doctor advised that the right big toe did not require a cast and that I could use buddy taping to stabilize the first and second toes.
The ulnar styloid fracture of my right wrist was to continue being immobilized with a short arm splint, but there were suspicions of a TFCC injury and DRUJ instability.
No further examinations were performed at that time, and I was instructed to continue monitoring and return for a follow-up in one month.
It has now been about three weeks; I only remove the cast while showering and wear it at all other times.
However, I still experience pain when performing supination with my wrist, and I can only rotate it halfway.
I would like to ask the doctor: 1.
Is the management of my right big toe appropriate? How long will it take to heal? Is it acceptable to walk using my heel and the outer side of my foot up to this point? 2.
For the ulnar styloid fracture of my right wrist, if there is suspicion of a TFCC injury and DRUJ instability, is it acceptable to only use immobilization and observation without surgery? How long will healing take in this case? Will there be any long-term complications? Thank you, Doctor!

Xiao Guo, 20~29 year old female. Ask Date: 2021/06/01

Dr. Shi Guozheng reply Orthopedics

1.
Toe fractures typically heal in about three months.
The physician's management is reasonable, and if walking is not painful, it is permissible to walk.

2.
If there is suspicion of other injuries, further imaging studies are necessary, and then a consultation with a hand surgery specialist should be sought to determine if surgery is required.

Reply Date: 2021/06/01

More Info

In your case, you have experienced both an ulnar styloid fracture and a fracture of the proximal phalanx of your right big toe due to a fall. Understanding the recovery and treatment for these types of fractures is crucial for ensuring proper healing and regaining function.

1. Treatment for Right Big Toe Fracture: The approach taken by your physician to use buddy taping (taping the injured toe to the adjacent toe) instead of a cast is a common practice for non-displaced toe fractures. This method allows for mobility while providing sufficient support to the injured area. Typically, toe fractures can take about 4 to 6 weeks to heal, depending on the severity of the fracture and the individual’s healing capacity. During this time, it is advisable to avoid putting excessive weight on the injured toe. Walking on the heel and the outer side of the foot, as you are currently doing, is a reasonable adaptation to minimize pain and protect the injury.

2. Management of Ulnar Styloid Fracture: The ulnar styloid fracture, particularly if it is non-displaced, can often be managed conservatively with a short arm splint. The suspicion of a triangular fibrocartilage complex (TFCC) injury and distal radioulnar joint (DRUJ) instability is significant, as these injuries can lead to complications if not properly addressed. While observation is a valid approach, it is essential to monitor for any signs of instability or worsening symptoms. If you continue to experience pain during supination (the outward rotation of the forearm), it may indicate that the TFCC is indeed injured or that there is some instability at the DRUJ.
Healing for ulnar styloid fractures typically takes about 6 to 8 weeks, but if there is associated soft tissue injury (like a TFCC tear), the recovery may take longer, and rehabilitation may be necessary to restore full function. It is crucial to follow up with your orthopedic specialist, who may recommend imaging studies such as an MRI to assess the TFCC and DRUJ more thoroughly if symptoms persist.

3. Potential Complications: Both injuries can lead to complications if not managed appropriately. For the toe, complications may include malunion or nonunion, which could affect your ability to walk normally. For the wrist, if the TFCC is indeed injured and not treated, it could lead to chronic pain, instability, and decreased range of motion in the wrist.

4. Next Steps: It is advisable to return to your orthopedic specialist for a follow-up appointment, especially since you are experiencing pain with wrist movements. They may consider further imaging or a referral to a hand specialist if necessary. In the meantime, continue to rest the affected areas, apply ice to reduce swelling, and elevate your hand and foot when possible.
5. Rehabilitation: Once healing has progressed, physical therapy may be beneficial for both the wrist and toe to regain strength and range of motion. Your therapist can provide exercises tailored to your specific injuries and recovery goals.

In summary, while the initial management of both fractures seems appropriate, ongoing symptoms warrant further evaluation. It is essential to communicate any changes in your condition to your healthcare provider to ensure a comprehensive treatment plan that addresses both the fractures and any associated injuries.

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