Radial styloidectomy has been used to treat radial-sided wrist pain secondary to radioscaphoid arthritis and impingement. It has been utilized in patients with previous fractures of the radial styloid or scaphoid, scaphoid nonunions, scaphoid nonunion advanced collapse (SNAC), early stages of scapholunate advanced collapse (SLAC), and Kienböck’s disease (1,2,3,4,5,6,7,8). It is particularly useful in patients with SLAC or SNAC wrists who retain good grip strength and range of motion (ROM), and do not want to compromise their function with definitive salvage procedures such as a proximal row carpectomy (PRC), or a limited or complete fusion. It is considered an early salvage procedure and although it does not directly address the mechanical wrist derangement, it may provide clinically significant pain relief.

Radial styloidectomy may also be a useful adjunct to procedures where a potential exists for postoperative impingement between the radial styloid and the scaphoid or trapezium (5,9,10). It has been combined with scaphoid-trapezium-trapezoid fusion (STT), four-corner fusion (fusion of the capitate, hamate, lunate, and triquetrum) and PRC (Fig. 17-1A,B). Rogers and Watson (9) reported on 31 of 91 patients treated with triscaphe arthrodesis whose procedures were complicated by persistent radial-sided wrist pain. The pain was attributed to radial styloid impingement, and the authors concluded that radial styloidectomy should be routinely included in the procedure when performing fusion of the scapho-trapezial-trapezoidal joint.

Anatomic and biomechanical studies have noted the importance of the radial styloid as an origin of the dorsal and palmar radiocarpal ligaments (Fig. 17-2), (11,12,13). The most significant ligaments on the radial side of the wrist are the radial collateral ligament (RCL), the radioscaphocapitate ligament (RSC), and the long radiolunate ligament (LRL) (11,14). The RSC and LRL ligaments originate 4 mm and 10 mm from the tip of the styloid process, respectively. Injury to these ligaments has been associated with perilunar instability of the wrist (15).

An isolated radial styloidectomy is ill advised in cases of incompetence of the palmar extrinsic ligaments, specifically RSC and LRL. It is also contraindicated with ulnar translation of the carpus,
because the radial styloidectomy may further destabilize the carpus. Isolated radial styloidectomy only addresses pathology of the radial aspect of the radioscaphoid articulation. Therefore, other procedures may be required to address the problems associated with more advanced SNAC or SLAC wrists, with extensive involvement of the scaphoid fossa or midcarpal joint.

Three basic types of osteotomies have been described: short oblique, vertical oblique, and horizontal (7,9,12

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