Malunion

Definition

 

Flexed "humpback" deformity

- intrascaphoid angles >35^o

- alters kinematics of wrist

 

Aetiology

 

Unstable displaced fracture

- non operative treatment

- distal segment flexes

- unites in poor position

 

NHx

 

DISI deformity

- carpal collapse

- pain and posttraumatic arthritis

 

Symptoms

 

Initially 

- pain

- reduced motion

- reduced grip strength

 

Eventually

- arthritis

 

Management

 

Osteotomy

- volar approach

- osteotomy with osteotome

- cortico-cancellous bone graft

- cannulated screw