Management of the Comminuted Fractures of the Ulnar Head and Neck Combined with Distal Radius Fractures by Darrach Procedure and Tenodesis of Extensor Carpi Ulnaris

ABSTRACT

PURPOSE: To evaluate the surgical results of distal radioulnar fractures managed by open reduction and internal fixation for the fractures of the distal radius and excision of the fractured fragments and ECU tenodesis for the comminuted fractures of ulnar head and neck. METHODS: Six cases of combined fractures of the distal radius and ulna were enrolled. Distal radius fractures were fixed by ORIF with AO locking plate without bone graft. The comminuted fragments of distal ulnar head and neck were excised and the tenodesis using half strip of ECU was added to stabilize the proximal ulnar stumps. After immobilization for 6 weeks, active ROM exercise started. The change of radial inclination and volar tilt, the ulnar shift and collapse of carpal bone and ulnar impingement were investigated with simple X-ray. Patients were assessed with residual subjective symptoms and modified Mayo wrist score (MMWS). All were female and average age was 68(58~75) years. Average follow up was 23(10~50) months. RESULTS: Resting pain was absent in all patients but heavy lift made them feel weakness and discomfort intermittently. All patients returned to the normal daily activities except one patient handicapped by hemiplegia. The average range of motion and grip power was 89% and 85% compared to the contralateral side respectively. The average MMWS was 87(75~95). The postoperative loss of the reduction of the distal radius was not observed in follow up X-ray. CONCLUSION: ORIF of distal radius fractures associated with the excision of the distal ulnar fragments and stabilization procedure using half strip of ECU may be one good method for the treatment of the fractures of the distal radius combined with the comminuted distal ulnar fractures difficult to be managed by ORIF. The intermittent weakness felt in this method made it not suitable in young active patient doing heavy work. AO locking plate was strong enough to maintain reduction until bone union.