Nonunion of the distal radius is a rare complication (0.2%) which gradually can lead to deformity, pain and dysfunction of the hand. We examined 7 patients who developed nonunion of the distal radius after surgical intervention and we try to rationalize this complication.

Our material consisted of 7 patients (2 male and 5 female) average 51 years old (31–75). Two patients with distal radial malunion, developed nonunion after corrective osteotomy. Four patients with comminuted metaphyseal radial fracture and concomitant distal ulna fracture, developed nonunion after application of an external fixator alone or in combination with internal fixation. Finally one patient with isolated fracture of the distal metaphysis developed nonunion after internal fixation. All patients after the confirmation of the nonunion and until radiological union underwent 1–3 operations. The index procedures for final union were wrist arthrodesis (1 patient) radioscapholunate fusion with excision of the distal scaphoid (2 patients) and internal fixation (4 patients). Additionally, in 6 patients a supplementary method for DRUJ asymmetry was needed.

Results were estimated after a mean follow-up of 30,8 months (1–4 years) based on radiological and clinical criteria. There were 1 excellent, 5 good and 1 fair result.

Despite the existence of predisposing factors (comminution, associated fracture of the distal ulna, metabolic disease, osteoporosis, distraction through external fixator), the contribution of the surgeon to the development of the nonunion is undeniable.

Introduction: Internal fixation of distal radius fractures with dorsal plates (when needed) comprise two potential problems: efficacy of stabilization and the high frequency of tendonitis which forced us to early removal of the hardware. Our purpose is to study the efficacy of the method of stabilization with 2 plates (2mm) the central and radial columns of distal radius according to the technique presented by Regazzoni (1993).

Material and Methods: Eight patients (5 males and 3 females), average 35 years old (range, 20–52 years) were treated with comminuted intraarticular fracture type C (6 patients) or malunion of distal radius (2 patients). A combined approach was used in 4 patients and only dorsal approach in the rest 4 patients. In all patients with recent comminuted fractures a supplementary fixation method with allograft were used. In patients with mal-united fractures the technique with two plates together with iliac graft were applied.

Results: Results estimated after mean follow-up of 14 months (range 9–18 months) according to clinical (pain, range of motion, and grip strength) and radiological (articular congruency, radial height, radial inclination and palmar tilt) criteria. Six patients revealed excellent or good result although two patients with loss of reduction needed a second operation.

Conclusion: We concluded, that when the technique with 2 plates was applied correctly the stability of fixation enhanced because the detrimental rotational forces were cancelled while the frequency of tendon irritation decreased.