gms | German Medical Science

Objectives/Interrogation: Severe ulna minus variance caused by congenital ulna minus variance can lead to a painful DRUJ. Clinically compression at the DRUJ leads to increasing pain at forearm rotation. Radiologically incongruence at the DRUJ with malformation is noticed

Methods: Based on the clinical experience in a young female athlete where painful ulnar minus variance of about 5mm following excessive ulnar shortening was solved by correction osteotomy with shortening and radial shift of the radius we treated meanwhile 32 patients with congenital ulnar minus and painful DRUJ in the same way. Depending on the amount of malformation an oblique closing wedge osteotomy is performed. It is important that the distal part of the osteotomy is done at the proximal border of the sigmoid notch and the proximal part beneath the joint surface of the ulnar head. The amount of shortening depends on the preoperative situation. The distal part is shifted radially and fixation is done with a fixed angle plate. Due to the wedge osteotomy the increased angle of the sigmoid notch is reduced leading to reshaping of the DRUJ.

Results and Conclusions: All osteotomies showed primary healing. 30 patients reported significant pain relief and no restriction of forearm rotation. One patient who was satisfied on his right side suffered continuous pain after correction on the opposite site and was converted into hemiresection of the ulna head. The second patient got instability of the DRUJ after correction where ligamentous reconstruction with distally attached brachioradialis tendon was done.

By corrective osteotomy with shortening of the radius and radial shift reshaping of the DRUJ can be observed. The key point of this procedure seems the decompression at the DRUJ by reducing the tension of the distal interosseous membrane which is gained by radius shortening and additional ulnar shift of the radius shaft. Preoperative instability at the DRUJ should be respected as contraindication for this procedure.