Malunion of the Distal Radius with Palmar Translation of the Articular Surface

9 Malunion of the Distal Radius with Palmar Translation of the Articular Surface

Indications

Fractures with disruption of the palmar cortex that have healed with palmar subluxation of all or a portion of the articular surface.

Pearl

Scrutinize the preoperative radiographs for evidence of posttraumatic arthritis of the distal radioulnar joint (DRUJ). A CT scan is often helpful when a definitive diagnosis cannot be made on the basis of plain radiographs.

Technique

Palmar approach via zigzag incision over flexor carpi radialis (FCR) sheath. Retract FCR radially (Fig. 9-1).
Incise floor of FCR sheath. Elevate pronator quadra-tus off of radius by subperiosteal dissection working from radial to ulnar.
Elevate the brachioradialis off the radial styloid.
Identify the plane of the previous fracture with an osteotome (Fig. 9-2). Check with intraoperative fluoroscopy.
Separate and elevate the palmarly translated fragment from the surrounding soft tissues and bone. Preserve the palmar radiocarpal ligaments.