Isolated Ulnar Shortening Osteotomy for a Distal Radius Malunion in a Young Female: A Cosmetic and Functional Success Story.

Introduction: Distal radius malunions are common complications of conservatively treated wrist fractures, often presenting with pain, deformity, and functional limitations. While corrective distal radius osteotomies are standard, isolated ulnar shortening osteotomy (USO) may offer a simpler alternative in select cases, particularly where radial shortening and positive ulnar variance are the primary issues. Case Report: We report the case of a 20-year-old female who presented 3 years after a conservatively treated distal radius fracture. Her complaints included wrist deformity, reduced grip strength, and intermittent pain. Imaging revealed a distal radius malunion with dorsal tilt and radial shortening, resulting in a positive ulnar variance of +4 mm, while the distal radioulnar joint (DRUJ) remained congruent. Surgical intervention involved an USO, during which a 1 cm wedge of bone was resected. At 1-year follow-up, she demonstrated excellent range of motion, full grip strength, no pain, and was highly satisfied with the cosmetic outcome. Conclusion: In selected cases of distal radius malunion with radial shortening and preserved DRUJ congruity, isolated USO can be an effective surgical solution to address both cosmetic and functional concerns.