The Darrach procedure for post-traumatic reconstruction


Published online: Jun 27 2009

Pieter Bas De Witte, Mathieu Wijffels, Jesse B. Jupiter, David Ring

From the Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA

Abstract

Over a 6-year-period, 15 women and 11 men with a mean age of 53 years (range, 24 to 80 years) had resection of the distal part of the ulna (Darrach's procedure) to address stiffness, instability, non-union, or substantial radioulnar length discrepancy after trauma. At an average follow-up of 21 months (range, 4 to 60 months), the improvement in total arc of forearm rotation averaged 87° (range, 0° to 160°), from an average of 49° to an average of 136° (p < 0.001). The proportion of patients with occasional or continuous pain after the Darrach procedure (7 after vs. 16 prior ; p = 0.04) was significantly reduced. Only two patients had reoperation related to the residual ulna. In this study, the Darrach procedure improved forearm rotation and pain in patients with posttraumatic stiffness, instability, nonunion, or substantial radio ulnar length discrepancy with a low complication and re-operation rate.