Ulnar Shortening Osteotomy After Distal Radius Fracture Malunion: Review of Literature

Abstract

Malunion of distal radius fracture is often complicated with shortening of the radius with disturbed radio- ulnar variance, frequently associated with lesions of triangular fibrocartilage complex and instability of the distal radioulnar joint. Positive ulnar variance may result in wrist pain located in ulnar part of the joint, limited ulnar deviation and forearm rotation with development of degenerative changes due to the overloading that occurs between the ulnar head and corresponding carpus. Ulnar shortening osteotomy (USO) is the standard procedure for correcting positive ulnar variance. Goal of this procedure is to minimize the symptoms by restoring the neutral radio - ulnar variance. In this paper we present a variety of surgical techniques available for ulnar shorthening osteotomy, their advantages and drawbacks. Methods of ulnar shortening osteotomies are divided into intraarticular and extraarticular. Intraarticular method of ulnar shortening can be performed arthroscopically or through open approach. Extraarticular methods include subcapital osteotomy and osteotomy of ulnar diaphysis, which depending on shape can be transverse, oblique, and step cut. All of those osteotomies can be performed along wrist arthroscopy in order to dispose and treat possibly existing triangular fibrocartilage complex injuries. At the end we described surgical procedures that can be done in case of ulnar shorthening osteotomy failure.

Keywords: malunion; techniques; ulna; ulnar shorthening osteotomy; ulnar variance; wrist.

Fig. (1)

Radio-ulnar variance measurement.

Fig. (2)

Radiogram showing postoperative neutral radio-ulnar variance achieved.

Fig. (3)

Methods of ulnar shortening. A) Wafer procedure; B) Subcapital osteotomy- fixation with a locking plate; C) Distal osteotomy with screw fixation; D) Diaphyiseal transverse osteotomy; E) Diaphyseal oblique osteotomy; F) Diaphyseal step-cut osteotomy; G) Darrach procedure; H) Sauvé- Kapandji procedure; I) Hemiresection- interpositional arthroplasty.