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Bone and Spine

Orthopedic health, conditions and treatment

Darrach Procedure

By Dr Arun Pal Singh

In this article
    • Technique of Darrach Procedure

Darrach procedure is removal of distal ulna. It was first performed by Darrach in 1911 in New York City. Darrach Procedure is done for-

  • For relief of pain following distal RU disruption and/or RU arthritis;
  • For symptomatic malunion of Colle fracture in elderly patients, especially when stiffness is present

Darrach  procedure is generally performed on elderly patients with low functional demands. Young pts with symptomatic instability of distal radio ulnar joint  may have better results with distal radial osteotomy and with restoration of length & alignment, or when this is not possible then consider hemi-resection arthroplasty.

Technique of Darrach Procedure

Darrach procedure is performed by  dorsal approach by longitudinal incision is made over distal ulna. It involves resection of 1-2 cm of  ulna.

Frequently, Darrach procedure is performed in conjunction with other procedures such as inflammatory arthropathies.  In this situation, the surgical incision is usually dorsal midline longitudinal, which enables all aspects of the wrist reconstruction like wrist fusion, arthroplasty, tenosynovectomy, tendon transfer etc.

If the Darrach procedure is to be performed independently, a single oblique or chevron dorsal approach is made  overlying the fifth dorsal compartment.

A  capsulotomy deep to the fifth dorsal compartment  is performed.

Osteotomize the distal ulna using a power oscillating saw just proximal to the sigmoid notch. Keep resection to 2 cm or less.

Intraoperative fluoroscopic guidance is frequently helpful to assist with the location of the osteotomy.

Entire styloid should be removed with the distal ulna.

Idea is to resect the minimum possible he least amount of bone is excised which is sufficient to restore full motion. If ulna appears unstable after resection, it may be stabilized  by tendon of extensor carpii ulnaris.

Complications

  • Instability of the distal ulnar shaft
  • Painful subluxation of the exteensor carpii ulnaris over the transected end
  • Palmar or ulnar subluxation of the carpal  bones
  • Radio-ulnar impingement (Bones converge together)
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Filed Under: Procedures, Trauma

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

Reader Interactions

Comments

  1. bruce nelson says

    March 16, 2015 at 10:41 pm

    wondering recovery time for darroch procedure

  2. Arun Pal Singh says

    March 17, 2015 at 11:09 am

    Would you elaborate please.

  3. blackie says

    September 7, 2015 at 6:16 pm

    Good day. One doctor says darrachs procedure and the other sauve-kapandji. Pros/cons between the two? Male 44 self-employed.
    Mechanical field so the hands work hard. Any/all insight would be appreciated.
    Regretably no medical aid.
    Regards.

  4. Arun Pal Singh says

    September 15, 2015 at 4:38 pm

    What is the indication for surgery?

  5. Roni Truhlar says

    November 12, 2015 at 8:17 pm

    When surgeon cuts off the bone when performing Darrachs Procedure, what happens to the marrow?

  6. Dr Arun Pal Singh says

    November 26, 2015 at 2:58 pm

    Marrrow of the part would come off with the removed bone. But that does not affect the function of marrow on the whole in other parts of the body, if that is your concern.

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