Arch Hand Microsurg.  2019 Jun;24(2):103-111. 10.12790/ahm.2019.24.2.103.

Surgical Treatment for Malunited Radius Fracture with Distal Radioulnar Joint Instability

• Shim JW
• Park MJ

• KMID: 2448043
• DOI: http://doi.org/10.12790/ahm.2019.24.2.103

Abstract

PURPOSE
The purpose of this study is to report the results of surgical treatment for malunited radius shaft fracture combined with distal radioulnar joint (DRUJ) instability.
METHODS
A retrospective review of patients with malunited radius shaft fracture with DRUJ instability from 2002 to 2015 was performed. All patients underwent corrective osteotomy for malunited radius. Anatomical distal radioulnar ligament reconstruction was additionally performed in patients who had remaining instability after correction. Preoperative and postoperative the anteroposterior stress test, range of motion, pain visual analogue scale, grip strength, modified Mayo wrist score, and disabilities of the arm, shoulder and hand score were analyzed.
RESULTS
A total of 13 patients with an average age of 25 years (range, 15-41 years) were included. The mean follow-up period was 35 months (range, 24-66 months). The DRUJ joint became stable in 4 patients after corrective osteotomy, and thus, no further procedures were required. For 9 patients, additional ligament reconstruction was performed at the same time after osteotomy. DRUJ stability was obtained in 11 patients at the final follow-up. One patient, who failed to achieve DRUJ stability due to insufficient correction, underwent redo-osteotomy. Mild limitation of rotation was observed in 4 patients. Clinical scores were significantly improved after surgery.
CONCLUSION
Restoration of DRUJ alignment by osteotomy is mandatory for treatment of malunited radius combined with DRUJ instability. Additional anatomical ligament reconstruction may improve DRUJ stability.

Keyword

Wrist; Instability; Malunited; Osteotomy; Reconstruction

MeSH Terms

Arm
Exercise Test
Follow-Up Studies
Hand
Hand Strength
Humans
Joint Instability*
Joints*
Ligaments
Osteotomy
Radius Fractures*
Radius*
Range of Motion, Articular
Retrospective Studies
Shoulder
Wrist

Figure

• 

  Fig. 1. (A) Preoperative wrist posteroanterior and lateral radiographs of a 24-year-old woman showed distal radioulnar joint subluxation associated with radial malunion. (B) Computed tomography showed volar subluxation of the ulna. This patient was treated with osteotomy and distal radioulnar ligament reconstruction. (C) Radiographs obtained one year after the surgery showed restored alignment. Note that the bone tunnels for ligament reconstruction in the distal radius and ulnar head are visible (arrowheads).

• 

  Fig. 2. (A) Preoperative wrist posteroanterior and lateral radiographs of a 15-year-old man showed distal radioulnar joint (DRUJ) subluxation associated with radial malunion. (B) After one year after surgery, he still had grade 3 instability after corrective osteotomy, and ligament reconstruction failed to restore DRUJ alignment. Corrective osteotomy was performed again. (C) Radiographs obtained one year after re-do osteotomy show improved alignment and stability.

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