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Clinical Example: Ulnar shortening osteotomy for distal radius fracture
malunion
| Distal radius fractures are most likely
to give long-term symptoms when malunion involves intra-articular incongruity,
shortening, or residual dorsal angulation. Frequently, shortening
results in malalignment of the distal radial ulnar joint, and may result
in ulnolunate impaction syndrome. If joint surfaces are preserved,
these last two problems may be corrected surgically with either corrective
osteotomy of the distal radius or ulnar osteotomy. Ulnar osteotomy
may be performed with corrective angulation, or as in this case, with simple
shortening. Chronic changes in the distal radial ulnar joint may
prevent reduction of the distal radio ulnar joint by traction produced
by shortening ulnar osteotomy. This case demonstrates a technique
in which ulnar osteotomy is combined with complete mobilization of the
distal ulna to allow release and synovectomy of the distal radial ulnar
joint from a proximal access. |
| Click on each image
for a larger picture |
| Preoperative radiographs demonstrate
radial shortening and relative ulnar lengthening and ulnar carpal abutment. |
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| Ulnar head prominence is obvious, associated
with a fixed radial deviation of the wrist. |
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| The ulna is approached through its
subcutaneous border. Provisional fixation of the plate to the distal
segment is used to plan the osteotomy, which is marked here. |
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| An oblique section of ulna is removed
with a saw. This may be done free hand by making a partial cut with
a saw blade, then leaving an unattached blade in the first osteotomy path
to provide a visual aid for a second parallel cut. |
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| After osteotomy, the distal ulna is
freed circumferentially out through the distal radioulnar joint, leaving
ulnar styloid attachments. |
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| The distal radioulnar joint and ulnar
head can be accessed from below. |
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| A longitudinal saw cut partially into
the cortex prior to ulnar osteotomy provides an additional aid in realignment
for the final fixation. |
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| Late result: proper ulnar alignment
restored. |
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| The osteotomy and plate position are
planned using a seven hole plate with a compression screw positioned obliquely
across the osteotomy cut. |
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| Late result - healed. |
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| Late range of motion. |
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