Salvage Procedures for the Distal End of the Ulna: There Is No Magic

Resection of the distal end of the ulna is not a benign procedure; nor is it a panacean surgical treatment of disorders at the distal radioulnar and ulnocarpal joints. Over the past 96 years, since Darrach first described his classic procedure, many authors have warned surgeons of the consequences of the Darrach resection. For salvaging the persistently painful distal forearm after Darrach resection, researchers have recommended a spectrum of possible surgical options. Each has its advantages and disadvantages; none substitutes completely for the painless, load-bearing capacity of a healthy distal radioulnar joint. Resection of the seat of the distal ulna eliminates the fulcrum of the ulna through which load is transferred from the hand to the forearm. At this time, there is still no surgical “magic” available to the reconstructive surgeon for salvaging normal use of the upper limb after failed Darrach resection.