Nonunion of distal radial fractures associated with distal ulnar shaft fractures: a report of four cases.

Although complications following distal radial fractures are common, nonunion is rare. We report four cases of radial nonunion following distal radial fractures that occurred in elderly women after low-energy falls. The distinctive feature of these injuries was the presence of an associated distal ulnar shaft fracture. All patients had initial closed reduction and cast immobilization, which was unsuccessful. Reconstruction was complicated by deformity, disuse osteoporosis, radiocarpal stiffness, and distal radioulnar joint disruption. Wrist arthrodesis improved function and decreased pain and deformity in three patients. Metaphyseal distal radial fractures associated with distal ulnar shaft fractures represent an unstable injury pattern, and closed reduction and casting may not be adequate treatment. Once established nonunion is present, wrist arthrodesis is a useful salvage procedure.