به نام خداوند بخشنده و مهربان. Distal radial malunion Dr hossein akbari aghdam M.D Assisted professor of Isfahan medical faculty.

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Presentation transcript:

به نام خداوند بخشنده و مهربان

Distal radial malunion Dr hossein akbari aghdam M.D Assisted professor of Isfahan medical faculty

Not all distal radial malunion are symptomatic

causes  Failure to achavie or maintainin reduction  Marked comminution  Sever osteoporosis  Disruption of DRUJ  Older 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

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