Darrach Procedure

By Dr Arun Pal Singh

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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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

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Technique of Darrach Procedure

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