Radial styloid fracture

Background

  • Also referred to as a Hutchinson or Chauffeur's fracture
  • Often accompanied by lunate dislocation
  • Often associated with carpal instability (carpal ligaments insert on the radial styloid)

Clinical Features

  • Wrist pain
  • Common mechanisms include direct blow to or fall onto radial aspect of wrist[1]

Differential Diagnosis

Distal radius fractures

Distal radius fracture eponyms

Eponyms Description
Barton's Fracture-dislocation of radiocarpal joint (with intra-articular fracture involving the volar or dorsal lip)
Chauffer's Fracture of radial styloid
Colles' Dorsally displaced, extra-articular fracture
Die-punch Depressed fracture of the lunate fossa (articular surface)
Smith's Volar displaced, extra-articular fracture

Evaluation

  • PA and lateral views of the wrist

Management

General Fracture Management

  • Acute pain management
  • Open fractures require immediate IV antibiotics and urgent surgical washout
  • Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
  • Consider risk for compartment syndrome
  • If any limitation to range of motion, orthopedics will often perform elbow arthrocentesis to remove hemarthrosis which is often present
    • The purpose of this is to see whether range of motion is restored after aspiration since if it is not, this may be an indication for surgery
    • This is generally not necessary to perform in the ED but can be done for patient comfort

Acute Reduction

  • Reduce displaced fractures to align attachments at the radial styloid process[1]

Immobilization

  • Short arm splint; position wrist in mild flexion and ulnar deviation

Disposition

  • Outpatient

See Also

References

  1. 1.0 1.1 German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.