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و بخشنده خداوند نام بهمهربان
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