Abstract
Background Malunion is a common complication of distal radius fractures. Ulnar shortening osteotomy
(USO) may be an effective treatment for distal radius malunion when appropriate indications
are observed.
Methods The use of USO for treatment of distal radius fracture malunion is described for
older patients (typically patients >50 years) with dorsal or volar tilt less than
20 degrees and no carpal malalignment or intercarpal or distal radioulnar joint (DRUJ)
arthritis.
Description of Technique Preoperative radiographs are examined to ensure there are no contraindications to
ulnar shortening osteotomy. The neutral posteroanterior (PA) radiograph is used to
measure ulnar variance and to estimate the amount of ulnar shortening required. An
ulnar, mid-sagittal incision is used and the dorsal sensory branch of the ulnar nerve
is preserved. An USO-specific plating system with cutting jig is used to create parallel
oblique osteotomies to facilitate shortening. Intraoperative fluoroscopy and clinical
range of motion are checked to ensure adequate shortening and congruous reduction
of the ulnar head within the sigmoid notch.
Results Previous outcomes evaluation of USO has demonstrated improvement in functional activities,
including average flexion-extension and pronosupination motions, and patient reported
outcomes.
Conclusion The concept and technique of USO are reviewed for the treatment of distal radius
malunion when specific indications are observed. Careful attention to detail related
to surgical indications and to surgical technique typically will improve range of
motion, pain scores, and patient-reported outcomes and will reduce the inherent risks
of the procedure, such as ulnar nonunion or the symptoms related to unrecognized joint
arthritis.
Level of Evidence: Level IV
Keywords
distal radius fracture - malunion - ulnar shortening osteotomy - ulnar wrist pain
- ulnar abutment
