Darrach Procedure — (Distal Ulna Resection)

UW Health · UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation

Weight-Bearing

NWB surgical UE; weight bearing capacity permanently limited post-op

Key Restrictions

No forearm ROM weeks 0-4; no lifting/pushing/pulling throughout; custom muenster orthosis weeks 1-6; no sports until 12 weeks; no resistance during forearm rotation except isometrics in neutral; weight bearing capacity permanently reduced — encourage full forearm supination when lifting; avoid aggressive stretching throughout

Timeline & Phases

Phase I (7-14 days): muenster orthosis, gentle AROM shoulder/wrist/digits/thumb from 2 weeks post-op, finger tendon gliding, edema/scar management; Phase II (3-4 weeks): muenster continues, gentle short-arc wrist AROM <45° forearm in full supination, heat prior to exercises; Phase III (6 weeks): add gentle forearm rotation supination→neutral, AAROM wrist 30-sec end-range holds, wrist widget/Modabber for forearm ROM, transition to OTS wrist orthosis; Phase IV (8-12 weeks): passive forearm rotation (stabilize ulna proximal to wrist, rotate/translate radius), hand strengthening in supination, light weights from 10 weeks; isometrics only in neutral for forearm; wean orthosis from 8 weeks, discontinue at night by 12 weeks

Notes

UW Health / UnityPoint Health - Meriter Rehabilitation; OT-based; distal ulna removed just proximal to sigmoid notch with wrist capsule reconstruction; review operative note — may include pronator quadratus transfer or FCU/ECU tenodesis; weight bearing capacity permanently limited post-Darrach — interosseous membrane/ligaments stabilize ulna in full supination; forearm supination facilitated with elbow flexed; pronation facilitated with elbow extended; wrist widget/Modabber reduces dorsal ulna-on-radius impingement during ROM; avoid aggressive stretching — surgery goal is pain elimination

Surgeon / Author

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation