Reconstructive salvage technique after failed Darrach procedure. A, Pronator quadratus (white arrows), held by hemostats, is mobilized free from its palmar-medial insertion on ulna in preparation for interosseous transfer to dorsomedial aspect of ulna. B, Hole is drilled approximately 1.5 cm proximal to distal end of ulna, through which harvested half of extensor carpi ulnaris (ECU) (asterisk) is passed in preparation for longitudinal tenodesis. C, Half of ECU prepared for longitudinal tenodesis of distal ulna (DU); free end is reflected distally and anchored to itself under appropriate tension before pronator quadratus transposition. D, Diagrammatic representation of components of salvage reconstruction. ECU longitudinal tenodesis retards radioulnar impingement, and pronator quadratus transfer retards dorsal translation. Temporary percutaneous pinning of distal radioulnar joint allows complete soft-tissue healing; by 6 weeks, stability can be maintained independently of hardware. (A-C, From Kleinman WB: Salvage procedures for the distal end of the ulna: there is no magic, Am J Orthop 38:172, 2009. D, Redrawn from Kleinman WB, Greenberg JA: Salvage of the failed Darrach procedure, J Hand Surg 20A:951, 1995.) SEE TECHNIQUE 69.38.