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Corrective Radial and Ulnar Osteotomies for Distal Radial Fracture Malunion
Takuro Wada, MD1; Masahiro Tatebe, MD2; Yasuhiro Ozasa, MD1; Osamu Sato, MD3; Tomoko Sonoda, DDS4; Hitoshi Hirata, MD2; Toshihiko Yamashita, MD1
1 Department of Orthopaedic Surgery, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan. E-mail address for T. Wada: twada@sapmed.ac.jp. E-mail address for Y. Ozasa: ozasa.yasuhiro@mayo.edu. E-mail address for T. Yamashita: tyamasit@sapmed.ac.jp
2 Department of Hand Surgery, Nagoya University, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan. E-mail address for M. Tatebe: tatebe@med.nagoya-u.ac.jp. E-mail address for H. Hirata: h-hirata@med.nagoya-u.ac.jp
3 Orthopaedic Clinic, Hakodate Goryokaku Hospital, 38-3, Goryokaku-cho, Hakodate 040-8622, Japan. E-mail address: semeru2005@ninus.ocn.ne.jp
4 Department of Public Health, Sapporo Medical University, South 1, West 17, Chuo-ku, Sapporo 060-8556, Japan. E-mail address: tsonoda@sapmed.ac.jp
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Based on an original article: J Bone Joint Surg Am. 2011 Sep 7;93(17):1619-26.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2012 Jun 13;2(2):e11 1-12. doi: 10.2106/JBJS.ST.K.00024
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We describe a technique consisting of simultaneous radial closing-wedge and ulnar shortening osteotomy to treat malunion of distal radial fractures.

Step 1: Preoperative Planning

Plan the radial closing-wedge osteotomy to correct the volar tilt angle to 8.5° to 15.5° and the ulnar shortening osteotomy to restore ulnar variance to −2.5 to 0.5 mm.

Step 2: Radial Closing-Wedge Osteotomy

Remove the wedge of bone from the radius and reduce the distal fragment, keeping the dorsal cortex as a hinge.

Step 3: Distal Ulnar Shortening Osteotomy

Resect the section of the ulna equivalent to the positive ulnar variance with transverse osteotomies.

Step 4: Plate Fixation of the Radial Osteotomy Site

Hold together the two fragments of the radius with a Kirschner wire and fix the osteotomy site with a volar locking plate.

Step 5: Proximal Ulnar Shortening Osteotomy

Evaluate residual ulnar positive variance with fluoroscopy and restore the ulnar variance to within a normal range by removing additional bone from the proximal fragment.

Step 6: Plate Fixation of the Ulnar Osteotomy Site

Use a compression device to close and fix the ulnar osteotomy site.

Step 7: Postoperative Management

Allow early motion immediately after the operation.


We retrospectively evaluated forty-two patients at a minimum of one year after treatment of an extra-articular distal radial malunion with a radial corrective osteotomy.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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