Treatment of Nonunion of the Ulnar Styloid by Low-Intensity Pulsed Ultrasound in a Baseball Player

Fractures of the ulnar styloid are generally treated conservatively and have been shown not to influence the final clinical result.[1] However, some patients suffer painful nonunion of the ulnar styloid. Low-intensity pulsed ultrasound (LIPUS) has been used as a therapy to support bone healing. Successful treatment with LIPUS of ununited fracture with small fragment has been reported.[2] We report a chronic nonunion of ulnar styloid fracture in a 13-year-old baseball player. He suffered from ulnar-sided wrist pain for 2 years. The radiograph of his left wrist showed an apparent nonunion at the base of the ulnar styloid ([Fig. 1]). As a treatment, his wrist was immobilized with a long arm cast for 3 weeks, and LIPUS treatment using Sonic Accelerated Fracture Healing System (Exogen, Piscataway, New Jersey, United States) was adapted over the ulnar styloid process. LIPUS treatment was conducted 20 minutes daily for 4 months by the patient himself. After 4 months of treatment, the pain at the ulnar styloid disappeared. Union at the fracture site was confirmed on the plane radiograph ([Fig. 2]). He returned to the baseball game without wrist pain. Hauck et al reported that ulnar styloid nonunion is categorized into two types based on the anatomic basis.[3] They defined type 1 of ununited ulnar styloid as a nonunion with a stable distal radioulnar joint (DRUJ) and type 2 as a nonunion with subluxation of the DRUJ. In this case, the DRUJ joint was stable, and the condition was considered as type 1 nonunion. Repeated stress to the ulnar side during the baseball practice caused the symptomatic pain at the nonunion site. The bone union with LIPUS treatment was achieved in this case since the patient is young, and the epiphyseal of distal ulnar is still open, which indicate that the potential of bone formation is higher than an adult. Although resection of ulnar styloid is widely reported in nonunion case, treatment with LIPUS should be considered in the adolescent case.

Fig. 1 Radiograph of the left wrist showed an apparent nonunion at the base of the ulnar styloid.

Fig. 2 The radiograph showed union at the fracture site after treatment of low-intensity pulsed ultrasound for 4 months.

• References

• 1 Wijffels M, Ring D. The influence of non-union of the ulnar styloid on pain, wrist function and instability after distal radius fracture. J Hand Microsurg 2011; 3 (01) 11-14
• 2 Fujioka H, Tanaka J, Yoshiya S. et al. Ultrasound treatment of nonunion of the hook of the hamate in sports activities. Knee Surg Sports Traumatol Arthrosc 2004; 12 (02) 162-164
• 3 Hauck RM, Skahen III J, Palmer AK. Classification and treatment of ulnar styloid nonunion. J Hand Surg Am 1996; 21 (03) 418-422