Distal radius malunion: outcomes following an ulnar shortening osteotomy

Paul H C Stirling, William M Oliver, Nathan Ng, Christopher W Oliver, Margaret M McQueen, Samuel Molyneux, Andrew Duckworth

Research output: Contribution to journalArticlepeer-review


Positive ulnar variance following a distal radius malunion can lead to ulnar-sided wrist pain, loss of grip strength, and distal radioulnar joint impingement. The primary aim of this study is to describe upper-limb specific functional outcomes following ulnar shortening osteotomy (USO) for ulnar-sided wrist pain associated with malunion of the distal radius.
We retrospectively identified 40 adult patients from a single centre over a 9-year period that had undergone an USO for symptomatic malunion of the distal radius. The primary outcome was the Patient-Rated Wrist Evaluation (PRWE). Secondary outcomes were the QuickDASH, EQ-5D-5L, complications, and Net Promoter Score (NPS).
Outcomes were available for 37 patients (93%). The mean age was 56 years and 25 patients were female (68%). At a mean follow-up of six years (range 1-10 years) the median PRWE was 11 (IQR: 0-29.5), the median QuickDASH 6.8 (IQR: 0-29.5), and the median EQ-5D-5L index was 0.88 (IQR: 0.71-1). The NPS was 73. Complications occurred in nine patients (24%) and included nonunion (n=4), early loss of fixation requiring revision surgery (n=1), superficial wound infection (n=2), neurological injury (n=1), and further surgery for symptomatic hardware removal (n=1).
For patients with a symptomatic distal radius malunion where the predominant deformity is ulnar positive variance, this study has demonstrated that despite 1 in 4 patients experiencing a complication, USO can result in excellent patient reported outcomes with high levels of satisfaction.
Level of Evidence: III (Cohort Study)
Original languageEnglish
Number of pages6
JournalEuropean Journal of Orthopaedic Surgery and Traumatology
Early online date6 Jul 2022
Publication statusE-pub ahead of print - 6 Jul 2022


  • Outcome
  • Ulnar shortening osteotomy
  • Distal radius malunion


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