Chauffeur Fracture (Radial Styloid Fracture)

What is a chauffeur fracture?

A chauffeur fracture is a broken bone near your wrist. There are two long bones in your forearm: the radius and the ulna. A chauffeur fracture occurs when the pointed tip at the end of your radius (radial styloid process) breaks.

A chauffeur fracture is a type of distal radius fracture, which means the break is at the end of the radius bone. A chauffeur fracture also extends into your wrist joint. When a fracture crosses into a joint, providers call it an intraarticular fracture.

Chauffeur fractures have many names, including radial styloid fractures, Hutchinson fractures and backfire fractures.

Who might get a chauffeur fracture?

Anyone can get a chauffeur fracture, but most people with distal radius fractures are either active younger people or people over age 65. Older people with osteoporosis are at higher risk.

Distal radius fractures are the most common fracture treated by U.S. healthcare providers. This type of fracture makes up nearly 17% of all fractures treated in emergency rooms. More than 450,000 people in the U.S. have distal radius fractures each year.

Why is it called a “chauffeur fracture”?

French orthopaedic surgeon Just Lucas-Championnière named this fracture after the many chauffeurs who started cars in the early 20th century. At the time, people started cars by vigorously turning a crank-handle clockwise. Sometimes the start of the motor caused the crank handle to jerk back. This led to a person’s hand twisting backward at the wrist and breaking the tip of the radial bone.

What causes a chauffeur fracture?

Trauma to your wrist causes a chauffeur fracture. This trauma may result from a:

• Fall onto an outstretched hand.
• Blow to the back of your wrist.
• Car accident.
• Sports injury.

What are the symptoms of a chauffeur fracture?

If you have a chauffeur fracture, you may experience the following symptoms in your wrist:

• Bruising.
• Limited motion.
• Pain.
• Swelling.
• Tenderness.
• Unusual bend, bump or twist to your wrist.

How is a chauffeur fracture diagnosed?

Your healthcare provider will ask about symptoms and examine your wrist and other parts of your body for signs of trauma. They’ll also do a neurologic assessment to check for nerve function in your arm and hand. They may also do the following:

• X-ray: This diagnostic imaging test shows the location of the fracture, as well as the number of pieces of broken bone. Your provider will also look at radial length, often comparing both of your wrists.
• CT (computed tomography) scan or magnetic resonance imaging (MRI): These noninvasive tests can confirm fractures and show related damage to tendons, ligaments or soft tissue.

How is a chauffeur fracture treated?

Providers aim to put the broken bones back into their original place and keep them there while they heal. Treatment for a chauffeur fracture depends on:

• Severity of the fracture.
• Whether the injury happened in the hand you use most (dominant hand).
• Whether your bones have shifted (displaced).
• Your activity level.
• Your age.
• Other injuries to your arms or legs that may affect ability to function or bear weight.

Treatments for chauffeur fractures can be nonsurgical, though many of these fractures require surgery to heal. Treatments include:

Closed reduction and casting: Your provider will move your bones back into place if needed. This happens without making an incision into your skin. They will place a splint over your fracture for several days and then replace it with a plaster cast. Your provider may change your cast after two to three weeks and check X-rays along the way to ensure your fracture hasn’t changed. They usually fully remove your cast after about six weeks.

External fixation: Your provider places an external fixation (stabilizer) device across your wrist joint, attached by metal pins. They may use this treatment if bones fail to stay in place with a cast or you have multiple areas of trauma.

Limited open reduction: Your provider uses a small incision to move your bones back into their original place. Then, they use an external fixation device to maintain the position. Your provider may use this technique when your bones have shifted more than 2 millimeters.

Open reduction and internal fixation (ORIF): Your surgeon makes an incision in the volar part of your wrist (the front part, or the area where you feel your pulse). They reattach the pieces of your bone and hold them in place with a plate and screws. Some surgeons are now using 3D printing to create models of the area to increase accuracy.

Are there complications/side effects of treatment?

Complications of treatment vary from person to person. The most common complication is when a fracture heals in a less than optimal position (malunion). This can result in a bone that’s shorter, twisted or bent. Other complications may include:

• Arthritis.
• Bones that fail to heal (nonunion).
• Compartment syndrome, when muscle pressure reaches dangerous levels.
• Complex regional pain syndrome (CRPS), which causes pain and swelling.
• Infection.
• Joint or tendon injuries.
• Neurologic injuries, such as carpal tunnel syndrome.
• Pain, stiffness or loss of motion.
• Ulnar wrist pain.

How soon after treatment will I feel better?

Healing time after treatment varies from person to person. You may heal more slowly if you’re older or have other conditions such as osteoporosis or diabetes.

How can I reduce my risk of a chauffeur fracture?

You can reduce your risk of developing a chauffeur fracture by:

• Doing weight-bearing exercises, such as walking, jogging and dancing, and doing resistance exercises, such as lifting weights.
• Eating a healthy diet with enough calcium and vitamin D.
• Preventing or managing osteoporosis through diet, exercise and medication.
• Quitting smoking and using tobacco products.
• Talking to your doctor about medications you currently take that may negatively affect your body’s use of calcium and vitamins.
• Trying to prevent falls at home by installing handrails near your stairs or grab bars in your bathroom.
• Wearing wrist guards and protective gear if you play high-impact sports such as football or rugby or do activities such as in-line skating or snowboarding.

What can I expect if I have a chauffeur fracture?

If you have surgery for a chauffeur fracture, your surgeon will place a splint on your wrist for about two weeks. During your follow-up visit, they’ll give you a removable splint to wear for about four weeks.

A chauffeur fracture may cause pain for a few days to a few weeks. Your provider may recommend pain relief, such as ibuprofen and acetaminophen. They may prescribe a stronger medication for severe pain.

Your provider will also show you gentle exercises to keep your wrist and fingers moving. They may recommend physical therapy to build up strength and movement in your wrist.

Are there long-term effects from it?

You may have stiffness and pain in your wrist for up to two years. Physical therapy can help you regain motion in your wrist.

You can usually start light activities, such as swimming, about one to two months after cast removal or surgery. You can begin more energetic activities such as rugby or snowboarding about three to six months after cast removal or surgery.

Full recovery can take at least one year. Some people may experience permanent aching or stiffness, especially if:

• The injury was severe.
• They’re older than 50.
• They have osteoarthritis.

When should I see my healthcare provider?

See your provider if you’re not able to move your fingers within 24 hours after you get a cast or have surgery due to swelling or pain. You should try to regain the full motion of your fingers as soon as possible.

A note from Cleveland Clinic

A chauffeur fracture is a break in the radius bone near your wrist. Providers can successfully treat chauffeur fractures with a cast, an external fixation device or surgery. If you experience any complications after chauffeur fracture treatment, talk to your provider about whether medications or physical therapy may help. Most people are able to return to their regular activities within a few months after they recover.