• J Hand Surg Am · Mar 2012

    Case Reports

    Sigmoid notch reconstruction and limited carpal arthrodesis for a severely comminuted distal radius malunion: case report.

    • Francisco Del Piñal, Alexis Studer, Carlos Thams, and Eduardo Moraleda.
    • Department of Hand and Plastic Surgery, Hospital Mutua Montañesa, Instituto de Cirugía Plástica y de la Mano, Santander, Spain. drpinal@drpinal.com
    • J Hand Surg Am. 2012 Mar 1; 37 (3): 481-5.

    AbstractWe 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 corticoperiosteal 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.Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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