I think I made a mistake and I'm wondering if it's too late now to do something about it. Eight months ago, I fell when stepping into a hole in the yard that I didn't know was there. I broke off the tip of the radial bone but opted to just have a cast put on and not have surgery to take out the bone fragments. Now I'm having really a lot of pain and clicking on that side of the wrist. I can hardly even pick up a a piece of paper with that hand. Is it too late for the operation?
A quick review of anatomy might help us in our discussion here. At the end of the forearm, two bones meet the first row of bones in the wrist. The two bones in the forearm are the radius (on the thumb side) and the ulna (on the little finger side).
The ulnar styloid is a small projection of bone at the bottom of the ulna. You can see and feel this as a bump on the back of your wrist on the little finger side. A fall on to the outstretched hand is the most common way this bone gets broken. Nonunion ulnar styloid fractures aren't always painful. But when they are, there is usually a reason. It might be because there is abnormal motion at the nonunion site. Or there could be a tear of the triangular fibrocartilage complex (TFCC).
The triangular fibrocartilage complex (TFCC) describes a group of tough ligaments that hold the radius and ulnar together. The TFCC also connects the ulnar styloid to the bones in the wrist. The TFCC is a major stabilizer of the radioulnar and wrist joints.
Surgery to repair the broken styloid hasn't been very successful in the past. For patients who have a painful nonunion, the surgeon just removes the broken pieces and smoothes down any jagged edges that remain. But pain will persist if the TFCC is torn. Repair of the TFCC and any other damaged soft tissues may be needed.
The best thing to do at this point is to review your situation with your surgeon. An evaluation with imaging studies (e.g., X-rays, thermography, magnetic resonance imaging, ultrasound) can offer insight as to the underlying problem but also what to do about it.
Other patients with similar problems have delayed treatment and still been able to change the outcomes with additional treatment. Sometimes it's just a matter of an exercise program to improve the strength of the tendons and muscles around the joint. In other cases, corrective surgery is the best choice.
Themistocles S. Protopsaltis, MD, and David S. Ruch, MD. Triangular Fibrocartilage Complex Tears Associated with Symptomatic Ulnar Styloid Nonunions. In The Journal of Hand Surgery. August 2010. Vol. 35. No. 8. Pp. 1251-1255.
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