Radio-lunate arthrodesis for distal radial intraarticular malunion

Eleven cases of symptomatic distal radial intraarticular malunion were treated by radio-lunate arthrodesis from 1983 to 1991. The mean age was 35.3 years. There were 11 men, all manual workers. The mechanism was usually a high velocity injury. The time elapsed since injury was a mean 23 months (2-109 months). The range of motion was, on average, flexion 39 degrees, extension 27 degrees, radial deviation 10 degrees and ulnar deviation 20 degrees. Pain was present on light work and grip strength was 45% of the opposite side. The average step-off was 4.4 mm. The scapho-lunate gap was greater than 3 mm in three cases and 5 mm in one case. An ulnar translation of the carpus greater than 4 mm was present in four cases. Posterior subluxation was significant in three cases. The distal radio-ulnar joint (DRUJ) was totally destroyed in three cases, and incongruent in five. Radio-lunate arthrodesis is performed by a posterior approach. Other procedures were combined, mainly on the DRUJ. The average follow-up was 28.5 months (8-79 months). Healing was achieved in ten out of 11 cases in 45 to 90 days. Pain was absent or moderate after 4 months. The range of motion was 33 degrees in flexion, 39 degrees in extension, 17 degrees in radial deviation and 29 degrees in ulnar deviation. The average post-operative strength was 57% of the opposite side (19 kg/33). Eight patients returned to their previous work and two to lighter work.