Francisco del Piñal, MD, PhD, Alexis Studer, MD, Carlos Thams, MD, Eduardo Moraleda, MD

Journal of Hand Surgery Vol. 37, Issue 3, March 2012, Pages 481-485. Copyright © 2012 by the American Society for Surgery of the Hand.

ABSTRACT (full text pdf. below)

We present the case of a young patient with a severely comminuted, malunited, intra-articular distal radius fracture and complete disruption of the sigmoid notch. We reconstructed the malunited distal radioulnar joint by osteotomy and repositioning the displaced sigmoid notch fragments through a combined dorsal and volar approach. At the same time, we carried out a radioscapholunate arthrodesis with distal scaphoid excision. We used a free vascularized corti- coperiosteal flap from the medial femoral condyle to span the massive bone defect in the radius to obtain union. At the 2.5-year follow-up, the patient had essentially normal function of the distal radioulnar joint (painless, with 85° of active pronation and 75° of supination). He resumed work as a bricklayer without limitations. We conclude that sigmoid notch reconstruction by osteotomy is worthwhile in the setting of malunited distal radius whether or not the radiocarpal joint is reconstructable.