Radius shaft fractures often require operative treatment after skeletal maturity to restore functional range of motion. If the radial bow is not anatomically restored, pain and instability can occur from bony impingement and disruption of the distal radioulnar joint (DRUJ). We describe a 25-year-old woman with a radius shaft malunion and DRUJ instability. Eight years prior, at the age of 17, she underwent open reduction and internal fixation for a radial shaft fracture with subsequent reinjury at 10 weeks postoperatively. The reinjury was treated nonoperatively, and the patient went on to have painful range of motion and DRUJ instability. Radiographs at the time of presentation to our clinic revealed a bent compression plate. We performed surgical hardware removal, radial osteotomy with fixation, and DRUJ reduction. The patient healed and went on to have functional, painless range of motion with activities of daily living. While we do not have her prior records, we presume she re-fractured after her initial surgery, and the hardware subsequently failed. It is important to restore the normal radio-ulnar anatomic relationship in the forearm to give patients functional outcomes.

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