La “malunion”

Abstract

In healed distal radial fractures, malunion is a deviation from the anatomically correct alignment. Minimal malunion may be asymptomatic or cause mild-to-moderate clinical problems. When malunion causes weakness, posttraumatic arthritis, carpal instability, ulnar-carpal abutment and other problems, it should be examined and treated with corrective osteotomy. Furthermore, if in malunion the radius has maintained an acceptable volar tilt, but is shortened, and a symptomatic ulnar plus results, a shortening osteotomy of the ulna is the most common corrective measure. Multiple techniques can be used: in clinical situations of mild ulnar plus (less than 3 mm) arthroscopic shortening is indicated; otherwise, Darrach’s or Bower’s operations should be performed. If significant DRUJ arthritis exists, Kapandji’s operation or a prosthetic ulnar head implant may be used.