Acta Chir Orthop Traumatol Cech. 2019; 86(4):294-298 | DOI: 10.55095/achot2019/050

Distal Ulna Malunion as the Result of Distal Ulnar Shaft Fracture Treated by Three-Dimensional Corrective OsteotomyCase report

P. MELUZINOVÁ1,3,*, P. DRÁČ2,3,4
1 Klinika úrazové chirurgie, Masarykova nemocnice v Ústí nad Labem a Univerzita Jana Evangelisty Purkyně v Ústí nad Labem
2 Traumatologická klinika, Fakultní nemocnice Olomouc
3 Lékařská fakulta, Univerzita Palackého v Olomouci
4 Fakulta zdravotnických věd, Univerzita Palackého v Olomouci

The team of authors presents a case of the patient who suffered an isolated unstable extra-articular distal ulnar fracture, the surgical treatment of which was affected by a postponed management in consequence of inadequate primary treatment. The primary non-operative treatment resulted in a complex malunion ad latus, ad axim and ad peripheriam. The malunion which led to a painful restricted range of motion of the forearm (59%), decreased hand grip strength and significant limitation of activities of daily living was surgically treated by a triplane corrective osteotomy at 11 months after injury. At 12 months after surgery, a complete ulnar bone union was observed, the patient showed no residual wrist pain, the range of motion of the injured forearm reached 97 % of the range of motion of the unaffected forearm (side), and the hand grip strength was 95% of the hand grip strength in contralateral limb. The treatment outcome can be assessed as very good based on the Quick DASH score.
Displaced isolated distal ulnar fractures cause a change in the axial position of the distal end of the bone and can be associated with an injury to the stabilizers of the DRUJ. Thus, they can result in a limited range of motion of the forearm due to the impaired DRUJ biomechanics and development of early post-traumatic osteoarthritis of the DRUJ. The non-operative treatment is recommended only for stable and non-displaced fractures as well as fractures in which surgical treatment is contraindicated. Corrective osteotomy of the distal ulna is the method of choice in managing distal ulna malunion as a result of isolated distal ulnar shaft fractures in symptomatic patients. Good functional outcomes may be achieved if the anatomical position of DRUJ is restored.

Keywords: corrective osteotomy, distal ulnar fracture

Published: August 1, 2019  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
MELUZINOVÁ P, DRÁČ P. Distal Ulna Malunion as the Result of Distal Ulnar Shaft Fracture Treated by Three-Dimensional Corrective Osteotomy. Acta Chir Orthop Traumatol Cech. 2019;86(4):294-298. doi: 10.55095/achot2019/050. PubMed PMID: 31524593.
Download citation

References

  1. Baek GH, Lee HJ, Gong HS, Rhee SH, Kim J, Kim KW, Kong BY, Oh WS. Long-term outcomes of ulnar shortening osteotomy for idiopatic ulnar impaction syndrome: at least 5-years foppow-up. Clin Orthop Surg. 2011;3:295-301. Go to original source... Go to PubMed...
  2. Cooney WP III, Rayhack JM. Fractures of the distal ulna and radioulnar joint. In: Cooney WP III. The wrist. Lippincot Williams and Wilkins, Philadelphia. 2010, pp.893-902.
  3. De Smet L, Fabry G. Orientation of the sigmoid notch of the distal radius: determination of different types of the distal radioulnar joint. Acta Orthop Belg. 1993;59:269-272. Go to PubMed...
  4. Dymond IWD. The treatment of isolated fractures of the distal ulna. J Bone Joint Surg Br. 1984;66:408-410. Go to original source... Go to PubMed...
  5. Kang HJ, Shim DJ, Yong SW, Yang GH, Hahn SB, Kang ES. Operative treatment for isolated distal ulnar shaft fracture. Yonsei Med J. 2002;43:631-636. Go to original source... Go to PubMed...
  6. Lee SK, Kim KJ, Park JS, Choy WS. Distal ulna hook plate fixation for unstable distal ulna fracture associated with distal radius fracture. Orthopaedics. 2012;35:1358-1364. Go to original source... Go to PubMed...
  7. Moritomo H, Noda K, Goto A, Murase T, Yoshikawa H, Sugamoto K. Interosseous membrane of the forearm: lenght change of ligaments during forearm rotation. J Hand Surg Am. 2009;34:685-691. Go to original source... Go to PubMed...
  8. Nakamura R, Horii E, Imaeda T, Tsunoda K, Nakao E. Distal radioulnar joint subluxation and dislocation diagnosed by standard roentgenography. Skeletal Radiol. 1995;24:91-94. Go to original source... Go to PubMed...
  9. Pirela-Cruz MA, Goll SR, Klug M, Windler D. Stress computed tomography analysis of the distal radioulnar joint: a diagnostic tool for determining translational motion. J Hand Surg Am. 1991;16:75-82. Go to original source... Go to PubMed...
  10. Richards TA, Deal DN. Distal ulna fractures. J Hand Surg Am. 2014;39:385-391. Go to original source... Go to PubMed...
  11. Sauder DJ, Athwal GS. Management of isolated ulnar shaft fractures. Hand Clin. 2007;23:179-184. Go to original source... Go to PubMed...
  12. Stern PJ, Drury WJ. Complications of plate fixation of forearm fractures. Clin Orthop Relat Res. 1983;175:25-29. Go to original source...
  13. Tolat AR, Sanderson PL, De Smet L, Stanley JK. The gymnast's wrist: acquired positive ulnar variance following chronic epiphyseal injury. J Hand Surg Br. 1992;17:678-681. Go to original source... Go to PubMed...
  14. Tolat AR, Stanley JK, Trail IA. A cadaveric study of the anatomy and stability of the distal radioulnar joint in the coronal and transverse planes. J Hand Surg Br. 1996;21:587-594. Go to original source... Go to PubMed...
  15. Višňa P, Beitl E, Šmídl Z, Kalvach J, Jaganjac E. Revizní operace diafyzárních zlomenin předloktí. Acta Chir Orthop Traumatol Cech. 2007;74:342-348. Go to original source... Go to PubMed...