1. به نام خداوند بخشنده و مهربان

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

4. Not all distal radial malunion are symptomatic

5. causes  Failure to achavie or maintainin reduction  Marked comminution  Sever osteoporosis  Disruption of DRUJ  Older patient  Iadequate duration or type of immobilization

6.  Exteraarticular deformity  Intraarticular deformity  Distal radioulnar joint incongruity or instability

8. Intact distal radius  Radial inclination 22 degree  Radial heiht 11 _12 mm  Volar tilt 11 _12 degree  Ulnar variance +_2 mm

13. Malunion parameters  Intraarticular incongruity >2 mm  Dorsal angulation >20 degrees  10<degree if carpus not align  Radial inclination <10 degrees

15. clinic  Pain  Mechanical  Dystrophic  ROM  Druj instability  Grip strength

16. graphy  Ap and lat view of both wrist

17. Operative treatment  Pain and functional deficits interfere with daily activity  Minimally symptomatic young ‘ active patients Contrandication : reflex sympathetic dystrophy syn

18.  1.correct deformity  Intraarticulat  extraarticular  2. treat DRUJ pathology  3.salvage procedures

19. Extraarticular malunion  Early or delay surgery  Type of internal fixation  Palte and screw  Intramedullary  External fixator

20. Plate and screw  2.4 locking plate  Fixed angle  Variable angle  Volar  dorsal

23. Intramedullary fixation  Intramedullary nail

25. External fixator  Nonbridge  bridge

26. Bone graft

27. Open or close wedge  Young active patient open wedge  Osteoprosis ‘ distal ulna procedure  Close wedge

31. 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...

33. 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

34. DRUJ incongruity and arthrosis  Source of persistent compliants Pain Decrease rotation Decrease grip strength

35.  Ulnar shortening  Resection of the distal ulna