Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 3 2026 07 16 139 42 Hassan Zolghadr Orthopedic Surgeon, Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran Hesam Alitaleshi Assistant Professor, Department of Orthopedics and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Aysan Valinejad Student of Medicine, Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran 2026 01 02 2026 05 25 Background: Ulnar styloid fractures are frequently associated with distal radius fractures; however, their optimal management remains controversial. In particular, the necessity of fixation in relation to distal radioulnar joint (DRUJ) stability continues to be debated. Case Report: This article presents three representative clinical scenarios alongside a focused review of the current literature regarding ulnar styloid fracture management. The discussion emphasizes intraoperative assessment of DRUJ stability and its role in guiding treatment decisions. Conservative management is generally appropriate for minimally displaced or tip fractures, whereas selective fixation may be considered in displaced basal fractures associated with DRUJ instability. Conclusion: Management of ulnar styloid fractures should be individualized based on DRUJ stability rather than fracture union alone. Selective fixation in cases of true instability yields favorable outcomes, while routine fixation is not recommended. Nonunion of the ulnar styloid is often clinically insignificant, and avoidance of unnecessary surgical intervention may reduce complication rates. https://jost.tums.ac.ir/index.php/jost/article/view/765 https://jost.tums.ac.ir/index.php/jost/article/download/765/477