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Distal radial malunionDr hossein akbari aghdam

M.D

Assisted professor of Isfahan medical faculty

Not all distal radial malunion are symptomatic

causes

Failure to achavie or maintainin reductionMarked comminutionSever osteoporosisDisruption of DRUJOlder patient

Iadequate duration or type of immobilization

Exteraarticular deformity

Intraarticular deformity

Distal radioulnar joint incongruity or instability

Intact distal radius

Radial inclination 22 degree

Radial heiht 11 _12 mm

Volar tilt 11 _12 degree

Ulnar variance +_2 mm

Malunion parameters

Intraarticular incongruity >2 mm

Dorsal angulation >20 degrees

10<degree if carpus not align

Radial inclination <10 degrees

clinic

Pain

Mechanical

Dystrophic

ROM

Druj instability

Grip strength

graphy

Ap and lat view of both wrist

Operative treatment

Pain and functional deficits

interfere with daily activity

Minimally symptomatic

young ‘ active patients

Contrandication : reflex sympathetic dystrophy syn

1.correct deformity

Intraarticulat

extraarticular

2. treat DRUJ pathology

3.salvage procedures

Extraarticular malunion

Early or delay surgery

Type of internal fixation

Palte and screw

Intramedullary

External fixator

Plate and screw

2.4 locking plate

Fixed angle

Variable angle

Volar

dorsal

Intramedullary fixation

Intramedullary nail

External fixator

Nonbridge

bridge

Bone graft

• Bone graft

Open or close wedge

Young active patient

open wedge

Osteoprosis ‘ distal ulna procedure

Close wedge

Distal radius osteotomy technique. (A) Saw-cut parallel to joint. (B, C) Re-alignment of the radius to corrected position. (D) Placement of bone graft. (E) Placement of plate. (F) Final plate fixation. Reprinted with permission from Weiss and Fern...

Intraarticular malunion

Intraarticular osteotomy

young active patient

In simple articular fracture patterns

Salvage procedures

Post traumatic arthritis

Total wrist arthrodesis in young high demand

Osteoarthritis limited to radiocarpal

Partial arthrodesis

Radiolunate arthrodesis

DRUJ incongruity and arthrosis

Source of persistent compliants

Pain

Decrease rotation

Decrease grip strength

Ulnar shortening

Resection of the distal ulna