Laugier’s sign is an abnormal spatial relationship between the radial and ulnar styloid processes, indicative of a distal radius fracture. Normally, the radial styloid is more distal than the ulnar styloid; proximal migration of the radial styloid suggests fracture displacement.

Pathophysiology

• Normal anatomy:

  • The radial styloid lies distal to the ulnar styloid when viewed from the dorsal aspect of the wrist.

  • This alignment maintains wrist congruity and proper load distribution.

• Abnormal anatomy (distal radius fracture):

  • Fracture of the distal radius can cause radial shortening or proximal migration.

  • The radial styloid may become level with the ulnar styloid, reflecting displacement and misalignment.

Examination Technique

1. Patient positioning: Have the patient extend both wrists comfortably on a flat surface.

2. Inspection: Compare radial and ulnar styloid processes on both sides.

3. Palpation: Assess for tenderness, step-off deformity, or swelling.

4. Documentation: Record leveling of the styloid processes, side affected, and associated swelling or bruising.

Clinical Features

Differential Diagnosis

Special populations

• Elderly:

  • Osteoporosis increases risk of distal radius fractures with minimal trauma.

  • Styloid shortening may be subtle; comparison with contralateral wrist is critical.

• Children:

  • Growth plates must be considered; distal radius physeal fractures may alter radial styloid position differently.

Limitations

• Subtle displacement may be difficult to detect by inspection alone, especially in patients with edema.

• Must differentiate from anatomical variation or previous wrist deformities.

• Imaging (X-ray) is essential to confirm diagnosis and assess fracture pattern.

Patient Counseling

• Explain that the wrist alignment indicates a possible distal radius fracture.

• Advise immobilization until confirmed by X-ray.

• Highlight the importance of follow-up to prevent malunion or functional limitation.

• Discuss potential need for orthopedic intervention (casting, reduction, or surgery).

Conclusion

Laugier’s sign is a clinical indicator of distal radius fracture, detected by proximal migration of the radial styloid relative to the ulnar styloid. Recognition aids early suspicion, prompt imaging, and timely management to optimize functional outcomes.

References

1. Rockwood CA, Green DP, Bucholz RW, Heckman JD. Rockwood and Green’s Fractures in Adults. 9th ed. Philadelphia, PA: Wolters Kluwer; 2020.

2. Court-Brown CM, McQueen MM. Distal radius fractures. Lancet. 2003;361:939–944.

3. Rüedi TP, Buckley RE, Moran CG. AO Principles of Fracture Management. 3rd ed. Stuttgart: Thieme; 2007.

4. Laugier M. Étude clinique sur les fractures du radius distal. Rev Chir Orthop. 1912;1:105–112.