DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20211635

Radius-ulna shaft fracture with distal radioulnar joint instability in a case of ipsilateral malunited colles fracture: a case report

Neetin P. Mahajan, Prasanna Kumar G. S., Kishor Jadhav, Kartik Pande, Tushar Patil

Abstract


Malunion of the distal end of radius is a known consequence of the conservative management. The functional impairment depends on the severity of the deformity and it can be associated with distal radioulnar joint (DRUJ) instability. Subsequent radius ulna fracture in an elderly osteoporotic patient is a challenging task to manage. A 60 year old female patient came with radius ulna shaft fracture with DRUJ instability with ipsilateral malunited distal radius fracture. We managed with open reduction and internal fixation using 3.5 mm locking compression plate (LCP) with ulnar shortening and K wires for DRUJ. At one year, follow-up, patient is having good clinical and radiological outcome without any complications. Radius ulna shaft fracture in cases of malunited colles fracture with positive ulnar variance with DRUJ instability can be managed well with open reduction and internal fixation of radius-ulna shaft which provides stable fixation, ulnar shortening at the fracture site to maintain the neutral/negative ulnar variance and DRUJ fixation using K wires. Use of multiple vicryl sutures to tie the plate to the bone gives additional stability in osteoporotic bones till the fracture unites and prevents implant failure. Combination of the above mentioned procedures helps in getting good functional outcome in elderly osteoporotic patients.


Keywords


Malunited colles, DRUJ instability, Radius ulna shaft fracture

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References


Bushnell BD, Bynum DK. Malunion of the distal radius. J Americ Aca Orthopaed Surg. 2007;15(1):27-40.

Schweizer A, Fürnstahl P, Harders M, Székely G, Nagy L. Complex radius shaft malunion: osteotomy with computer-assisted planning. Hand. 2010;5(2):171-8.

Graham TJ. Surgical correction of malunited fractures of the distal radius. J Amer Aca Orthopaed Surg. 1997;5(5):270-81.

Shea K, Fernandez DL, Jupiter JB, Martin Jr C. Corrective osteotomy for malunited, volarly displaced fractures of the distal end of the radius. J Bone Joint Surg. 1997;79(12):1816-26.

Prommersberger KJ, Fernandez DL. Nonunion of distal radius fractures. Clinic Orthopaed Rel Resear. 2004;419:51-6.

Liverneaux PA. The minimally invasive approach for distal radius fractures and malunions. J Hand Surg. 2018;43(2):121-30.

Delclaux S, Pham TT, Bonnevialle N, Aprédoaei C, Rongières M, Bonnevialle P, et al. Distal radius fracture malunion: Importance of managing injuries of the distal radio-ulnar joint. Orthopaedic Traumatol Surg Resear. 2016;102(3):327-32.

Barbaric K, Rujevcan G, Labas M, Delimar D, Bicanic G. Ulnar shortening osteotomy after distal radius fracture malunion: review of literature. Open Orthopaedic J. 2015;9:98.