Bilateral stress fractures of the radial styloid processes in a gymnast

摘要

Dear Sir, An 18-year-old man, a Japanese National Team level gymnast, felt pain over the dorsum of both wrists when he was doing handstands and push-up activities on the floor. He had no major injuries or other identifiable causes. The pain increased gradually and he consulted about this. The range of motion of the wrist was limited: flexion was 60deg in the right wrist and 65deg in the left; extension was 75deg in the right wrist and 55deg in the left. AP radiographic views of the wrists showed fractures of the radial styloid processes, osteophyte formation at the distal end of the radial styloid processes and new bone formation at the fracture sites (Fig 1 A, B). On T2-weighted magnetic resonance imaging, high intensity signals were detected at the fracture sites and low intensity signals in the scaphoid bones, suggesting nonunion of the radial styloid processes and stress reactions in the scaphoid bones (Fig 1 C, D). We diagnosed stress fractures of the radial styloid processes and excised the fracture fragments in both wrists. After a 4 week period of immobilization in a short arm cast, he started physical exercise and returned to his original level of activity 2 months after operation. At the 2 year follow-up, he had no complaints about either wrist and there was no malalignment on further radiographs.