Main Article Content
distal radius, malunion, osteotomy, Darrach, bone graft, ulna plus, ulnar shortening
Malunion can occur in 11 to 28% of Distal Radius Fractures and can result in radius shortening and ulnar plus with wrist deviation, pain and disability. We aimed to report particular cases of extra-articular distal radius fracture malunion with severe radial deviation and ulnar plus treated by corrective osteotomy of distal radius with bone graft associated to ulnar procedure. One of these patients was firstly operated with ulna subtraction osteotomy synthesized with plate and in a second stage with distal radius corrective addition osteotomy with homologous bone graft, plate and external fixator. Two other cases were treated in a single-step by radius addition osteotomy and caput ulnae Darrach resection. These three patients were followed-up from 2 to 12 years, successfully observing the maintenance of anatomical correction and recovery of ROM and strength with good pain relief and return to daily activities. After Darrach procedure external-fixation wasn’t needed and pronation-supination was better. Darrach procedure can solve ulna plus and improve ROM in pronation-supination with a quicker healing, avoiding the risk of ulnar non-union. Darrach’s procedure associated to addition corrective osteotomy of distal radius can be a valid treatment for distal radius severe malunion, in patients with low-moderate functional demand. In conclusion, the surgeon should choose the right corrective treatment after the complete evaluation of the patient and his functional needs.
2. Lauri G. Pseudoartrosi del radio distale. Riv Chir Mano. 2012;49(2):110-2.
3. Graham TJ. Surgical Correction of Malunited Fractures of the Distal Radius. J Am Acad Orthop Surg. 1997;5:270-81.
4. Chung KC and Mathew AL. Management of Complications of Distal Radius Fractures. Hand Clin. 2015;31(2):205-15.
5. Goto K, Naito K, Sugiyama Y et al. Corrective Osteotomy with Autogenous Bone Graft with Callus after Malunion of Distal Radius Fracture. J Hand Surg Asian Pac. 2018;23(4):571-6.
6. Leigheb M, Bosetti M, De Consoli A, Borroni A, Cannas M, Grassi F. Chondral tissue engineering of the reumatoid knee with collagen matrix autologous chondrocytes implant. Acta Biomed. 2017;88 (S4):107-113.
7. Stecco A, Arioli R, Buemi F et al. Overcoming metallic artifacts from orthopedic wrist volar plating on a low-field MRI scanner. Radiol Med. 2018.
8. Marcuzzi A, Leigheb M. Transcapho-perilunate dislocation with palmar extrusion of the scaphoid proximal pole. Acta Biomed. 2016;87(S1):127-30.
9. Leigheb M, Sabbatini M, Baldrighi M, et al. Prospective analysis of pain and pain management in an emergency department. Acta Biomed. 2017;88(S4):19-30.
10. Oskam J, Bongers KM, Karthaus AJM, Frima AJ, Klasen HJ. Corrective osteotomy for malunion of the distal radius. Arch Orthop Trauma Surg. 1996;115(3-4):219-22.
11. Barbaric K, Rujevcan G, Labas M, Delimar D, Bicanic G. Ulnar shortening osteotomy after distal radius fracture malunion: review of literature. Open Orthop J. 2015;9:98-106.
12. Manjeet S, Siddhartha S, Chetan P et al. Wide resection and stabilization of ulnar stump by extensor carpi ulnaris for giant cell tumor of distal ulna: two case reports. Cases J. 2009;2:8617.