Ulnar Shortening Osteotomy After Distal Radius Fracture Malunion: Review of Literature

Katarina Barbaric*, 1, Gordan Rujevcan 2, Marko Labas 3, Domagoj Delimar 4, Goran Bicanic 4
1 Department of Orthopaedic Surgery, Clinical Hospital Centre Zagreb, Salata 6, 10000, Zagreb, Croatia
2 Department of Orthopaedic Surgery, General Hospital “Dr. Ivo Pedisic” Sisak, J. J. Strossmayera 59, 44000 Sisak, Croatia
3 Department of Orthopaedic Surgery and Traumatology, General Hospital Varazdin, Ivana Mestrovica 2, 42000 Varazdin, Croatia
4 Department of Orthopaedic Surgery, University of Zagreb School of Medicine, Clinical Hospital Centre Zagreb, Salata 6-7, 10000 Zagreb, Croatia

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© Barbaric et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Orthopaedic Surgery, Clinical Hospital Centre Zagreb, Salata 6, 10000, Zagreb, Croatia; Tel: +385 1 2368 986; Fax: +385 1 2379 913; E-mail:


Malunion of distal radius fracture is often complicated with shortening of the radius with disturbed radio- ulnar variance, frequently associated with lesions of triangular fibrocartilage complex and instability of the distal radioulnar joint. Positive ulnar variance may result in wrist pain located in ulnar part of the joint, limited ulnar deviation and forearm rotation with development of degenerative changes due to the overloading that occurs between the ulnar head and corresponding carpus. Ulnar shortening osteotomy (USO) is the standard procedure for correcting positive ulnar variance. Goal of this procedure is to minimize the symptoms by restoring the neutral radio - ulnar variance. In this paper we present a variety of surgical techniques available for ulnar shorthening osteotomy, their advantages and drawbacks. Methods of ulnar shortening osteotomies are divided into intraarticular and extraarticular. Intraarticular method of ulnar shortening can be performed arthroscopically or through open approach. Extraarticular methods include subcapital osteotomy and osteotomy of ulnar diaphysis, which depending on shape can be transverse, oblique, and step cut. All of those osteotomies can be performed along wrist arthroscopy in order to dispose and treat possibly existing triangular fibrocartilage complex injuries. At the end we described surgical procedures that can be done in case of ulnar shorthening osteotomy failure.

Keywords: malunion, techniques, ulna, ulnar shorthening osteotomy, ulnar variance, wrist.