Over a 6-year-period, 15 women and 11 men with a mean age of 53 years (range, 24 to 80 years) had resection of the distal part of the ulna (Darrach’s procedure) to address stiffness, instability, non-union, or substantial radioulnar length discrepancy after trauma. At an average follow-up of 21 months (range, 4 to 60 months), the improvement in total arc of forearm rotation averaged 87° (range, 0° to 160°), from an average of 49° to an average of 136° (p < 0.001). The proportion of patients with occasional or continuous pain after the Darrach procedure (7 after vs. 16 prior ; p = 0.04) was significantly reduced. Only two patients had reoperation related to the residual ulna. In this study, the Darrach procedure improved fore- arm rotation and pain in patients with posttraumatic stiffness, instability, nonunion, or substantial radio- ulnar length discrepancy with a low complication and re-operation rate. Keywords : distal ulna resection ; Darrach. INTRODUCTION Resection of the distal ulna as credited to Darrach (7, 19) may be considered for patients with dysfunction of the distal radial ulnar joint (DRUJ) resulting from trauma, inflammatory arthritis, or congenital deformities. In patients with post- traumatic DRUJ dysfunction, the indications for the Darrach procedure include pain, instability, and limited range of forearm motion. Most studies have reported satisfactory results of the Darrach procedure, with marked improvement in pain relief and range of movement, and minimal loss of grip strength (1,5,8,14,17,22,25-27). However, the Darrach procedure has fallen out of favour recently as a result of publications that reported failure of pain relief and poor outcome in some patients (2,3,9,12,13,23,24). Persistent pain after the Darrach procedure has been ascribed to instability of the ulnar stump, with or without impingement of the ulnar stump on the radius as described by Bell et al (2). Concern regard- ing ulnar stump instability has greatly reduced the appeal of the Darrach procedure to the point that many surgeons seem reluctant to consider this Acta Orthopædica Belgica, Vol. 75 - 3 - 2009 Acta Orthop. Belg., 2009, 75, 316-322 The Darrach procedure for post-traumatic reconstruction Pieter Bas DE WITTE, Mathieu WIJFFELS, Jesse B. JUPITER, David RING From the Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA ORIGINAL STUDY ■ Pieter Bas de Witte, BSc, Research Fellow. ■ Mathieu Wijffels, MD, Research Fellow. ■ Jesse B. Jupiter, MD, Hans-Jorg Wyss Professor of Orthopaedic Surgery Harvard Medical School and Chief. ■ David Ring, MD, PhD, Assistant Professor of Orthopaedic Surgery Harvard Medical School and Director of Research. Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA. Correspondence : David Ring, MD, PhD, Massachusetts General Hospital, Orthopaedic Hand and Upper Extremity Service, Yawkey Center Suite 2100, 55 Fruit Street, Boston, MA 02114, USA. E-mail : dring@partners.org © 2009, Acta Orthopædica Belgica. Disclosures : Unrestricted research grants from Small Bone Innovations, Wright Medical, Smith and Nephew, Tornier, Acumed, and Biomet.