Corrective osteotomy for symptomatic increased ulnar tilt of the distal end of the radius

Twelve wrists in 10 patients with a mean age of 23.6 years were treated for symptomatic increased ulnar inclination of the joint surface with corrective osteotomy of the radius. Diagnoses included mild ulnar dysplasia, posttraumatic deformity, Madelung's disease, and multiple hereditary exostosis. All patients had radial-sided wrist pain and an ulnarly displaced arc of radioulnar deviation. Preoperative radiographs showed excessive ulnar inclination of the distal radius, ulnar carpal translation, adaptive carpal malalignment, and frequent distal radioulnar joint incongruency. The patients had decreased pain and improved wrist function at a mean of 5.1 years (range, 2-10 years) after surgery. Average radial deviation changed from 3 degrees to 16 degrees and ulnar deviation from 48 degrees to 29 degrees; flexion/extension and pronosupination remained unchanged. Realignment of the wrist was shown radiographically by a change of ulnar inclination of the radius from 33 degrees to 21 degrees, an increase in scaphoid height from 16.4 to 20.4 mm, and reversal of ulnar carpal translation as shown by an increase in lunate-covering ratio of 64% to 77%. Reduction of the ulnar inclination to normal values by corrective radial osteotomy restores a more physiologic range of motion, decreases symptomatic wrist pain, reverts adaptive carpal changes to normal, increases lunate coverage, and may prevent abnormal cartilage overload in the ulnar compartment of the wrist.     

桡骨远端楔形截骨术治疗腕舟状骨不愈合及月骨坏死

目的评价桡骨远端楔形截骨术治疗腕舟状骨不愈合和月骨坏死的效果。方法应用桡骨远端楔形截骨术治疗腕舟状骨不愈合123例和月骨坏死32例。术中第一截骨线在桡骨茎突近端1.5 cm处,截骨方向与桡骨远端关节面平行;第二截骨线位于第一截骨线近端0.5~1.0 cm处,截骨方向与桡骨纵轴垂直;两截骨线在下尺桡关节中心会合。取出楔形骨块,桡偏使楔形截骨处对合,用1或2枚克氏针固定。结果术后平均随访25(6~60)个月。腕舟状骨折均愈合,平均愈合时间10(8~14)周。32例月骨坏死者中,13例硬化骨重新成活,余无明显改善。术后腕关节疼痛VAS评分、腕关节活动度及握力均较术前明显改善(P0.05);术后患侧腕关节活动度与握力与健侧比较无统计学差异(P0.05)。99例手功能正常,56例有轻微功能障碍。腕关节功能按Krimmer评分:优99例,良56例。结论桡骨远端楔形截骨术治疗腕舟状骨不愈合及月骨坏死的效果确切,操作简单,是值得推荐的一种有效方法 。     

Radiocarpal osteoarthritis associated with bilateral bipartite carpal scaphoid bones: a case report

Bipartite carpal scaphoid is a rare congenital anomaly. The authors report on a 56-year-old man who presented with bilateral wrist pain without a history of trauma. X-ray films demonstrated bilateral symmetric bipartition of the scaphoid into a large distal ossicle and a smaller proximal ossicle. There was degenerative change in the articulation between the distal ossicle and the radial styloid. The joint space between the proximal ossicle and the scaphoid fossa was preserved. The absence of periscaphoid degenerative change has been suggested as a criterion for the diagnosis of congenital bipartite scaphoid. This patient fulfilled all other criteria for the diagnosis and the authors suggest that degenerative change developed due to abnormally high contact force between the distal ossicle and the radial styloid. An identical pattern of degenerative change has been observed in long-standing nonunion of the scaphoid, likely due to a similar mechanism. Radiocarpal osteoarthritis can develop in patients with congenital bipartition of the scaphoid and is similar to that observed in long-standing nonunion of the scaphoid.     

Scaphoid nonunion and distal fragment resection: analysis with three-dimensional rigid body spring model

Background  Distal fragment resection is one of the salvage procedures for scaphoid nonunion with osteoarthritis. Despite being reported as a simple procedure with favorable midterm outcomes, further arthritic changes remain a concern in the long term. Scaphoid waist fracture is classified into volar or dorsal types according to the displacement pattern, but the indications for distal fragment resection have never been discussed for these fracture types. Method  We reconstructed a normal wrist model from computed tomography images and performed theoretical analysis utilizing a three-dimensional rigid body spring model. Two types of scaphoid fracture nonunion followed by distal fragment resection were simulated. Results  With volar-type nonunion, the force transmission ratio of the radiolunate joint increased, and the pressure concentration was observed in the dorsal part of the scaphoid fossa and volar part of the lunate fossa of the radius; no deterioration was seen in the midcarpal joint. In the distal fragment resection simulation for volar-type nonunion, pressure concentrations of the radiocarpal joint resolved. With dorsal-type nonunion, force transmission ratio in the radiocarpal joint resembled that of the normal joint model. Pressure concentrations were observed in the dorsoulnar part of the scaphoid fossa and radial styloid. The pressure concentration in the dorsoulnar part of the scaphoid fossa disappeared in the resection model, whereas the concentration in the radial styloid remained. In the midcarpal joint, pressure was concentrated around the capitate head in the nonunion model and became aggravated in the resection model. Conclusions  With volar-type scaphoid nonunion, distal fragment resection seems to represent a reasonable treatment option. With dorsal-type nonunion, however, pressure concentration around the capitate head was aggravated with the simulated distal fragment resection, indicating a potential risk of worsening any preexisting lunocapitate arthritis.     

Resection of the scaphoid distal pole for symptomatic scaphoid nonunion after failed previous surgical treatment

PURPOSE: To evaluate the results of resection of the scaphoid distal pole for symptomatic scaphoid nonunion after failed prior surgical treatment. METHODS: Thirteen patients who were treated with resection of the scaphoid distal pole for persistent nonunion after previous surgical treatment were included in this study. The mean follow-up period was 5 years. Evaluation included measurement of wrist range of motion, assessment of pain, and evaluation of radiographic parameters. The Disabilities of the Arm, Shoulder, and Hand score was used to determine the functional outcome after the excision. RESULTS: Before surgery all but 1 patient reported pain. After surgery 2 patients presented with mild pain during strenuous activity. Mean wrist flexion and extension increased significantly, by 23 degrees and 29 degrees, respectively. The postoperative Disabilities of the Arm, Shoulder, and Hand score was 25 +/- 19 points. There was a significant increase in the radiolunate angle, indicating dorsal intercalated segment instability deformity in 6 patients. CONCLUSIONS: Scaphoid distal pole excision remains a valuable treatment option for patients for whom multiple attempts at union have failed previously and who have no associated complete scapholunate ligament tears. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.     

Effects of a scaphoid waist osteotomy on carpal kinematics

The effects of a scaphoid osteotomy on the kinematics of the carpal bones were determined in five cadaveric wrist specimens. Minute radiographic markers were inserted into the distal radius and selected carpal bones through limited arthrotomies between the intercarpal ligaments. Simultaneous biplanar radiographs were obtained in neutral and the extreme wrist positions of extension, flexion, radial deviation, and ulnar deviation, both before and after a scaphoid waist osteotomy. The positions of each of the carpal markers and their corresponding carpal bones were digitized for each wrist position , and a computer-assisted motion analysis was performed for each specimen before and after transverse scaphoid waist osteotomy. Following the osteotomy, there was a tendency for the scaphoid osteotomy to collapse into a dorsally angulated or "humpback collapse" deformity during each extreme wrist position. There was also multiplanar osteotomy site motion as well as complex collapse deformities of the midcarpal joint associated with loss of the mechanical tie-rod function of the scaphoid. These findings reveal the importance of the scaphoid in maintaining normal kinematics and the inherent instability of these fractures with loss of scaphoid integrity.     

Vascularized bone graft from the iliac crest for the treatment of nonunion of the proximal part of the scaphoid with an avascular fragment.

BACKGROUND: It was hypothesized that nonunion of the proximal third of the scaphoid associated with avascular necrosis could be treated successfully with a free vascularized bone graft obtained from the iliac crest. METHODS: Fifteen patients who had a nonunion of the proximal part of the scaphoid that had been present for an average of two years and three months (range, nine months to seven years) were managed with use of a free vascularized bone graft obtained from the iliac crest. Avascularity of the scaphoid, as assessed on preoperative radiographs, was characterized by loss of trabecular structure, collapse of subchondral bone, and formation of bone cysts. The results of the procedure were assessed in terms of osseous union, pain, active motion of the wrist, and osteoarthritis. Postoperatively, vascularity of the scaphoid was evaluated with use of magnetic resonance imaging and color Doppler ultrasonography. The average duration of follow-up was six years and one month (range, two years and one month to eight years and one month). RESULTS: Preoperatively, one patient had had pain with any movement of the wrist and fourteen had had pain after strenuous manual labor or sports activity. The average pain score, derived with use of a 10-point visual analog scale, was 2.4 points (range, 1.0 to 6.7 points). Postoperatively, union was achieved in twelve patients; six were pain-free, and six had occasional pain during strenuous manual labor or sports activity, or both. The average pain score for these twelve patients was 1.1 points (range, 0.0 to 4.2 points) on the visual analog scale. Preoperatively, osteoarthritis was limited to the region between the radial styloid process and the distal part of the scaphoid in fourteen patients and to the radioscaphoid region in one patient. Postoperatively, the degree of osteoarthritis remained unchanged in seven of the twelve patients who had union and progressed to the radioscaphoid region in five. Vascularity, as seen on the imaging studies, was restored in all twelve patients who had union. The nonunion persisted in three patients, all of whom had progressive osteoarthritis leading to carpal collapse. CONCLUSIONS: The index procedure was successful in twelve of the fifteen patients who had a symptomatic nonunion of the proximal part of the scaphoid associated with avascular necrosis and osteoarthritis that was limited to the radioscaphoid joint.     

Surgical treatment of nonunion and avascular necrosis of the proximal part of the scaphoid in adolescents

BACKGROUND: The purpose of this retrospective study was to examine the clinical and radiographic results of treatment of proximal scaphoid nonunion and avascular necrosis with vascularized bone graft from the distal part of the radius in adolescent patients. METHODS: Between 1993 and 1996, three adolescents with a proximal scaphoid nonunion and avascular necrosis underwent vascularized bone-grafting and internal fixation. The mean age at the time of the fracture was 14.8 years (14.4, 14.6, and 15.3 years), and the mean time interval between the fracture and the surgery was 19.3 months (six, seventeen, and thirty-five months). We retrospectively reviewed all available clinical and radiographic data from the time of fracture to the time of the last follow-up. All patients were examined clinically and radiographically at the time of the review, at a mean of 5.5 years (five, five, and 6.5 years) after surgery. RESULTS: All fractures healed at a mean of 3.4 months (2.75, 3.0, and 4.5 months) postoperatively. Final follow-up radiographs showed union and revascularization of the proximal part of the scaphoid with no evidence of degeneration of the radiocarpal joint. None of the patients had limiting pain or scapholunate instability demonstrated on physical or radiographic examination. Dorsiflexion and radial deviation of the affected wrist were decreased by a mean of 22 degrees (10 degrees, 22 degrees, and 35 degrees ) and 15 degrees (5 degrees, 20 degrees, and 20 degrees ), respectively, compared with those of the normal wrist. CONCLUSION: Grafting with vascularized radial bone is an effective treatment, leading to union and good function, for nonunion and avascular necrosis of the proximal part of the scaphoid in adolescents.     

Die Arthrodese kleiner Gelenke am Beispiel des Daumensattelgelenks

OBJECTIVE: Elimination of pain, impairment of function, and loss of power due to basal joint osteoarthritis of the thumb. INDICATIONS: Idiopathic or posttraumatic osteoarthritis of the basal joint of the thumb. The technique is equally suitable for arthrodesis of the first tarsometatarsal joint or the first metatarsophalangeal joint following a failed Keller-Brandes operation or failed prosthesis. CONTRAINDICATIONS: Total or subtotal resection of the trapezium. Osteoarthritis of the distal scaphoid joint (triscaphoid joint). SURGICAL TECHNIQUE: Technique for a stable fixation of small joints, illustrated by arthrodesis of the carpometacarpal joint of the thumb. A plate is bent distally and used as a washer for a small-fragment compression screw, crossing the former joint space and the inserted bone graft. Additional compression is achieved by asymmetric drilling of the proximal screw (asymmetric insertion principle). POSTOPERATIVE MANAGEMENT: Plaster splint for 5 days, then early functional treatment. RESULTS: In a clinical trial, 16 patients with idiopathic basal joint osteoarthritis of the thumb (18 joints) were followed up for an average of 6 years postoperatively. The main objective of the operation, namely, pain relief, was achieved in all cases. Only one case required revision due to nonunion.     

以第一、二伸肌腱鞘支持带上动脉为血管蒂的桡骨瓣治疗舟骨骨不连

目的 探讨以第一、二伸肌腱鞘支持带上动脉(1,2 ICSRA)为血管蒂的桡骨瓣带蒂逆行转移治疗舟骨骨不连的手术指征、技术和疗效.方法 2007年2月至2010年10月,我科对15例舟骨骨不连患者,应用以1,2 ICSRA为血管蒂的桡骨瓣远端蒂转移植骨内固定进行治疗.其中腰部骨不连9例,近端骨不连6例.9例伴有近端骨折块缺血性坏死;3例伴有舟状骨弓背畸形及嵌入体背伸不稳(DISI);2例伴有桡骨茎突关节炎表现.所有病例均采用腕桡侧纵形切口,13例予以交叉克氏针内固定,2例行单枚Herbert螺钉附加1枚克氏针固定.12例将带血管蒂植骨块从舟骨背侧嵌插植入,3例将植骨块楔形修整后自舟骨掌侧植入.术后随访骨折愈合时间、腕痛、腕关节活动度及握力等情况.结果 术后随访时间为6～ 21个月,平均13个月,2例失访.所有随访病例X线片显示舟骨均获得骨性愈合,平均愈合时间为14.2周.所有患者腕痛消失,腕关节屈曲(59.92±4.82)°,背伸(49.73±4.58)°.根据改良的Mayo腕关节功能评分标准评定:优9例,良2例,可2例;优良率为84.6％.结论 以1,2 ICSRA为血管蒂的桡骨瓣逆行转移植骨手术,能促进舟骨骨不连的愈合,特别对有近端骨块缺血性坏死的患者疗效显著.     

Posttraumatic osteonecrosis and nonunion of distal pole of scaphoid

Posttraumatic osteonecrosis of distal pole of scaphoid is an extremely rare with only two reported cases so far. We present a case of a 30-year-old male with a 2-year-old posttraumatic osteonecrosis and nonunion of distal pole of scaphoid left wrist. He presented with complaints of pain and restriction of movements. There was no evidence of radiocarpal arthritis. He was managed with open reduction and internal fixation with k-wires, supplemented by a pronator quadratus based muscle pedicle bone graft. The fracture union was achieved at 6 months. After 2 years, he had almost complete range of wrist motion and had returned to his preinjury level of functional activity. His MRI (magnetic resonance imaging) scans showed evidence of revascularization suggesting successful incorporation of bone graft.     

Scaphoid reconstruction with vascularized bone grafts from the distal radius

The aim of the present technical report is to describe the alternative solutions for the reconstruction of scaphoid nonunions with pedicled vascularized bone grafts from the distal radius. The surgical technique for the reconstruction A. of proximal scaphoid nonunions with pedicled bone grafts (based on the 1,2 or on the 2,3 intercomparmtental arteries) or with capsular bone grafts from the dorsal distal radius and B. of waist nonunions of the scaphoid with grafts from the palmar distal radius, pedicled on the palmar carpal arch, is presented. Vascularized bone grafts from the adjacent radius are used for the treatment of scaphoid nonunions to enhance union and to revascularize a nonviable proximal pole. The most suitable graft is selected according to the location of the nonunion (at the waist or the proximal pole of the scaphoid) and to the previous procedures/scars at the wrist level.     

Scaphoid nonunions: a 3-dimensional analysis of patterns of deformity

We tested the hypothesis that the fracture location of scaphoid nonunions relates to the fracture displacement, development of dorsal intercalated segment instability (DISI) deformity, and changes in the contact area of the bones in the radiocarpal joint. Eleven patients with scaphoid nonunions were examined with 3-dimensional computed tomography and a new method of proximity mapping. Two different patterns of displacement of scaphoid nonunions were demonstrated, 1 volar and 1 dorsal. All patients with a volar pattern scaphoid nonunion had a DISI deformity. Only a few of the patients with a dorsal pattern scaphoid nonunion, mostly in longstanding nonunions, had a DISI deformity. The fracture line was generally distal to the dorsal apex of the ridge of the scaphoid in the volar-type fractures and proximal in the dorsal displaced fractures. The proximity map of the distal fragment of the scaphoid on the radius in the volar type shifts radial compared with normal; in the distal type it shifts dorsal. Neither of the patterns showed any significant changes of the proximity map in the radiocarpal joint at the proximal scaphoid fragment and the lunate. Whether the fracture line passes distal or proximal to the dorsal apex of the ridge of the scaphoid appears to determine the likelihood of subsequent fracture displacement, DISI deformity, and contact area of the bones in the radiocarpal joint.     

Dorsal capsular-based vascularized distal radius graft for proximal pole scaphoid nonunion with avascular necrosis

BackgroundScaphoid nonunion involving the proximal pole with the presence of avascular necrosis is difficult to reconstruct. We aimed to determine the efficacy of surgical treatment of proximal pole scaphoid nonunion with avascular necrosis using a dorsal capsular-based vascularized distal radius graft.MethodsBetween 2000 and 2018, 64 patients with established proximal pole scaphoid nonunion with avascular necrosis were treated using a dorsal capsular-based vascularized distal radius graft. This graft was harvested from the dorsal aspect of the distal radius with its dorsal wrist capsule attachment. Fixation of the scaphoid nonunion was performed with a small cannulated screw, followed by insertion of the vascularized graft into the dorsal trough at the scaphoid nonunion site. In the last 47 patients of this series, a micro suture anchor was placed into the scaphoid to augment graft fixation.ResultsUnion rate was 86% (55 of 64 scaphoid nonunions with avascular necrosis) at a mean time of 12 weeks. Persistent non-union was noted in eight patients and fibrous union in one patient. No patients developed donor site morbidity. No graft dislodgment was noted. There was significant improvement of the wrist functional outcomes at the final follow up.ConclusionsThe dorsal capsular-based vascularized distal radius graft is a safe and effective treatment in patients with scaphoid nonunion with avascular necrosis of the proximal pole. This pedicle vascularized bone graft is derived from a location that can easily reach the proximal third of the scaphoid avoiding microsurgical dissection or anastomosis.     

Long-term results of the minimal resection Darrach procedure.

Eighteen patients had a minimal resection Darrach procedure at the distal radial-ulnar joint for treatment of posttraumatic arthritis. The follow-up averaged 8 years (range, 2 to 18 years). Fourteen patients were completely satisfied with the result achieved with the procedure and four were mostly satisfied. No patient had either subjective or objective evidence of distal ulnar instability. Grip strength for patients without radiocarpal arthritis was 84% of the uninvolved side. Preoperative ulnar variance was plus 4 mm and at follow-up minus 4 mm. At follow-up examination, four patients had ulnar carpal translocation. The average radial inclination angle of the patients with ulnar carpal translocation was 24 degrees, compared with 18 degrees for patients without ulnar carpal translocation. The minimal resection Darrach procedure gives excellent relief of pain without the instability attributed to the Darrach procedure. It must be used judiciously in patients who have a radial inclination angle above 23 degrees.     

Degenerative changes at the scaphotrapezial joint following Herbert screw insertion: a radiographic study comparing patients with scaphoid fracture and primary hand arthritis

One method of Herbert screw insertion is to mobilize the scaphotrapezial joint and insert the screw through the articular surface of the distal scaphoid. Because of concern that this might predispose to osteoarthritis in the scaphotrapezial joint, we have investigated joint space width and the presence of osteophytes adjacent to the scaphotrapezial joint using high definition macroradiography.Twenty-eight patients with symptomatic primary osteoarthritis of their hands, 23 with a scaphoid fracture successfully treated conservatively and 18 treated with a Herbert screw were studied. The patients with primary osteoarthritis of their hands had more narrowing of the scaphotrapezial joint compared with the other two groups, but patients treated with a Herbert screw had a significantly higher incidence of osteophytosis on the distal scaphoid than the other two groups. With Herbert screw fixation, osteophytosis on the distal scaphoid may cause impingement and pain, and be a predictor of further degenerative joint changes.     

Surgical outcome of scaphoid nonunions in heavy manual workers

The management of scaphoid nonunion in heavy manual workers is challenging. Symptoms appear earlier and manual labor-related stress at the operated nonunion site may worsen the postoperative outcome. This study involved 16 heavy manual workers with scaphoid nonunion (11 cases involving the dominant hand) treated by internal fixation and autologous bone grafting. The nonunion was in 12 patients in the waist, in 3 patients in the proximal, and in 1 patient in the distal pole of the scaphoid. Clinical and radiographic evaluation of union was done according to the criteria of Bynum et al. and Fernandez and Eggli. Pain, wrist motion, and grip strength were evaluated and compared to the contralateral side. At a mean follow-up of 24 months (range, 10 months to 6 years), the mean range of motion and the grip strength compared to the contralateral hand were 95% and 91%, respectively. Overall hand function was excellent in 13 patients, good in 2 patients, and fair in 1 patient. All except one patient were pain free and returned to their work without or with minimal complaints at an average of 3.4 months (range, 2-6 months), postoperatively. In 15 patients, scaphoid nonunions healed at a mean time of 64 days. One patient had a reoperation, and union was observed at 90 days after the second operation. In all patients, the radiolunate angle was restored to normal. One patient developed complex regional pain syndrome that resolved completely after 2 months with adequate intensive physical therapy. Clinical symptoms of scaphoid nonunions are more severe and appear earlier in heavy manual workers; in this group of patients, surgical treatment is necessary. The double-threaded screw provides adequate stabilization for union. Autologous cancellous bone graft, because of its plasticity and malleability to exactly fill the scaphoid defect, is recommended.     

Distal scaphoid resection arthroplasty for the treatment of degenerative arthritis secondary to scaphoid nonunion

Nineteen patients with chronic scaphoid nonunion and associated degenerative arthritis between the distal fragment and the radial styloid were treated by resection of the distal fragment. All patients had a dorsal intercalated segment instability wrist collapse pattern with an average radiolunate angle of -32 degrees and a 10% reduction in the carpal height, both of which changed minimally during the follow-up period. The duration of the nonunion averaged 12 years and the follow-up period averaged 49 months. Range of motion improved 85% and grip improved 134%. Thirteen of the patients experienced complete pain relief. One patient required additional surgery and elected wrist arthrodesis. Resection of the distal fragment is not recommended for patients with capitolunate arthritis. Two of the 4 patients with capitolunate arthritis had persistent symptoms; 3 had progressive degenerative changes.     

桡动脉茎突返支为蒂桡骨茎突骨瓣植入术治疗舟骨骨折不愈合

目的总结以桡动脉茎突返支为蒂的桡骨茎突骨瓣移位治疗舟骨骨折不愈合的临床效果。方法2000年3月~2005年6月,对18例舟骨骨折不愈合的患者,以桡动脉茎突返支为蒂在桡骨茎突掀起1.5cm×3.5cm×0.5cm的骨瓣,植入沿舟骨纵轴跨越骨折线所凿同等大小的骨槽内进行治疗。其中男15例,女3例。年龄18~39岁。舟骨腰部骨折11例,近侧1/3骨折7例,其中5例舟骨近端骨折块伴缺血坏死。腕关节活动疼痛,尤以背伸及桡偏时明显,鼻烟窝处有压痛,腕关节活动受限,X线片示10例患者有骨折端硬化及囊性变,骨折线明显加宽。结果术后18例舟骨骨折均愈合,其中5例合并缺血坏死的舟骨骨折块重新成活,骨折平均愈合时间为4个月。术后获随访1~5年,患者腕关节活动良好,腕背伸时无疼痛,日常生活和工作无影响。结论采用桡动脉茎突返支为蒂的桡骨茎突骨瓣移位治疗舟骨骨折不愈合及近端骨折块缺血坏死,操作简便,治疗有效,具有一定临床应用价值。     

Distraction osteotomy for malunion of the distal end of the radius with radial shortening

The treatment and outcomes of distraction osteotomy in 9 patients with malunion of the distal radius with radial shortening are presented. The patients had an average age of 32 years (range: 14 to 36 years) and comprised 7 males and 2 females. Ulnar inclination was below normal in all patients, volar inclination was below normal in 8 patients, and the average radial length discrepancy was 7.6 mm (range: 4 to 16 mm). Angulations in the distal radius were corrected by manipulation after osteotomy, and shortening by callus distraction. In order to achieve normal radial length, distraction was performed for an average of 10.2 days (range: 7 to 19 days), and union occurred in an average of 10.7 weeks (range: 9 to 13 weeks). During the waiting period between distraction and consolidation, impairment of ulnar and volar inclination recurred in 3 patients, and translation of the distal fragment necessitating correction occurred in 3 patients. No cases of nonunion or malunion were observed. In all patients, there was a decrease in cosmetic and pain-related complaints, and improvement in wrist movements. Distraction osteotomy is a simple and effective treatment for malunion of the distal radius with concurrent radial shortening. However, the position of the distal fragment should be followed up until consolidation.