Treatment of post-operative infected nonunion distal radius fracture using the Darrach procedure and radioscapholunate fusion with volar locking plate.

There is no established standard treatment for post-operative infected nonunion distal radius fracture with severe damage to the joint surface. Herein, we report a case of post-operative infected nonunion distal radius fracture with severe articular damage, which was treated using a combination of the Darrach procedure and radioscapholunate fusion with a volar locking plate after implant removal and antibiotic treatment. A 61-year-old man underwent internal fixation with a volar locking plate for a distal radius fracture. Repeated post-operative infections caused distal radius nonunion, a bone defect in the lunate fossa of the radius, subluxation of the carpal bones on the palmar and ulnar sides, and significant limitation of rotation. Implant removal and wound debridement were performed to control infection. After oral antibiotic treatment, the Darrach procedure and radioscapholunate fusion with a volar locking plate combined with ulnar head bone grafting were performed. The patient was able to perform his activities of daily living without any problems after the two-stage surgery. This is the first report describing the treatment of post-operative infected nonunion distal radius fracture with severe damage to the radiocarpal and distal radioulnar joints.