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: Isolated compressive fractures of the scaphoid and lunate fossa of the distal radius are rare injuries and their closed reduction is almost impossible. Frequently the displacement becomes accepted and conservative treatment was applied which in the long-term could have catastrophic consequences concerning the fate of articular cartilage.

Material and Methods: Seven patients (6 males and 1 female) of mean age 30 years old (range 18–42) were studied with compressive fracture of scaphoid (4 patients) or lunate (3 patients) fossa. All patients (except one with compressive fracture of the lunate fossa who was treated early), were initially treated conservatively. Mean delay of surgical treatment was 36 days (3 patients) while two patients were operated 2 and 2, 5 years postinjury. One patient with fractured lunate fossa had concomitant fracture of the lunate. The vast majority of the patients underwent supplementary imaging techniques (CT scan, MRI, 3D-CT scan). The majority of patients were approached both intraarticularly and extraarticularly.

Results: Results were estimated after an average follow-up of 12 months (range, 6 months – 3 years) according to clinical and radiological criteria. Six patients revealed excellent or good result while one had a fair result.

Conclusion: In conclusion, operative treatment of these intraarticular fractures should be attempted independently of the time elapsed from injury on the premise that there are no arthritic changes and an adequate pre-operative planning has done.