Arch Hand Microsurg 2019; 24(2): 103-111  
Surgical Treatment for Malunited Radius Fracture with Distal Radioulnar Joint Instability
Jae Woo Shim, Min Jong Park
Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence to: Min Jong Park
Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
TEL: +82-2-3410-3506, FAX: +82-2-3410-0061, E-mail: mjp3506@skku.edu
Received: December 17, 2018; Revised: February 27, 2019; Accepted: March 4, 2019; Published online: June 1, 2019.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: The purpose of this study is to report the results of surgical treatment for malunited radius shaft fracture combined with distal radioulnar joint (DRUJ) instability.
Methods: A retrospective review of patients with malunited radius shaft fracture with DRUJ instability from 2002 to 2015 was performed. All patients underwent corrective osteotomy for malunited radius. Anatomical distal radioulnar ligament reconstruction was additionally performed in patients who had remaining instability after correction. Preoperative and postoperative the anteroposterior stress test, range of motion, pain visual analogue scale, grip strength, modified Mayo wrist score, and disabilities of the arm, shoulder and hand score were analyzed.
Results: A total of 13 patients with an average age of 25 years (range, 15-41 years) were included. The mean follow-up period was 35 months (range, 24-66 months). The DRUJ joint became stable in 4 patients after corrective osteotomy, and thus, no further procedures were required. For 9 patients, additional ligament reconstruction was performed at the same time after osteotomy. DRUJ stability was obtained in 11 patients at the final follow-up. One patient, who failed to achieve DRUJ stability due to insufficient correction, underwent redo-osteotomy. Mild limitation of rotation was observed in 4 patients. Clinical scores were significantly improved after surgery.
Conclusion: Restoration of DRUJ alignment by osteotomy is mandatory for treatment of malunited radius combined with DRUJ instability. Additional anatomical ligament reconstruction may improve DRUJ stability.
Keywords: Wrist, Instability, Malunited, Osteotomy, Reconstruction


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