Ulnar Styloid Base Fracture Fixation Using Resorbable Nails and Suture

There remains debate regarding the treatment of ulnar styloid fractures associated with distal radius fractures. We present a novel technique for basal ulnar styloid fracture fixation using absorbable pins and a suture tension band construct, leveraging the rotational stability of the tension band while minimizing impingement and hardware irritation. The procedure begins with an incision over the ulnar styloid to expose the fracture. Fracture fragments are cleared of soft tissue and reduced with a dental pick before temporary fixation with a K-wire. Absorbable nails are placed into the distal ulna, and a tension band construct is created using a suture passed through bone tunnels proximal to the fracture, providing additional compression. Fluoroscopic imaging confirms alignment before wound closure, and the wrist is immobilized in a splint until the first postoperative visit. This technique reduces soft tissue irritation by utilizing intramedullary absorbable implants instead of subcutaneous plates or K-wires and replacing steel wire with suture. Patients begin hand therapy at 7 to 10 days to regain wrist range of motion, progressing to strengthening at 4 to 6 weeks and full activity by 8 to 12 weeks. Given that over a third of ulnar styloid fractures involve the base, orthopedic surgeons should consider this approach to achieve fixation while minimizing complications.