Case Report of Customized Distal Radius Prosthesis Replacement: An Alternative Treatment for Post-traumatic Unreconstructable Intraarticular Distal Radius Malunion

Abstract

Severely comminuted intraarticular distal radius malunion can significantly affect a patient's quality of life. To date, there is no ideal solution. We propose customized distal radius prosthesis replacement as a treatment option. A 33-year-old policeman presented with left wrist deformity and loss of motion for five months following a distal radius fracture AO (Arbeitsgemeinschaft für Osteosynthesefragen) type-C3 which had been fixed with a volar locking plate incorporate with external fixation and Kirschner wire (K-wire) augmentation for two months. He needed to rely on wrist motion for work. Therefore, we fabricated a customized distal radius prosthesis based on his contralateral normal anatomy to replace the malunion site. The patient was satisfied and able to return to work two months after the operation. Thirty months later, the range of motion had improved from fixed 40° flexion and fixed 70° pronation deformity to 73° flexion, 79° extension, 75° supination, and 85° pronation. His DASH (Disabilities of the Arm, Shoulder, and Hand) score had improved from 80 to 14.2. His pain score, as measured by the visual analog scale, improved from eight preoperatively to two. Unreconstructable intraarticular malunion of the distal radius is a challenging problem with no treatment consensus. Customized distal radius prosthesis may provide a successful treatment option. Future research should elucidate long-term outcomes.

Salvage of Failed Distal Radius Open Reduction Internal Fixation With Long-Stem Total Wrist Arthroplasty

“… 3 It has been widely demonstrated that comminuted intra-articular malunions/nonunions considerably affect a patient’s quality of life. 4 Each of these factors should be considered when deciding on how to best treat an individual patient. However, there is a paucity of literature on how to best treat these complicated nonunions.…”

Total Wrist Arthroplasty as a Motion-Sparing Option for Distal Radius Malunion in a Patient of Advanced Age

“…Total wrist arthrodesis has previously been the treatment of choice for severe wrist arthritis or post-traumatic deformity and provides reliable, durable results at the cost of wrist motion 36 . The application of TWA for management of severe DRF malunion is an emerging concept that provides elderly patients with a motion-sparing option 24,37 . Darrach or Sauve-Kapandji can be used in patients with distal radius malunions to address the ulnar side of the wrist 13 .…”

“…Postoperatively, the patient was reportedly satisfied with results (DASH 80 preop, 14.2 postop; and VAS pain 8 preop and 2 postop) and was able to return to work 2 months after surgery. Although only sparsely reported in the literature, the use of TWA to treat severe post-traumatic injuries may provide a valuable option for patients who desire maximal upper extremity mobility 24,37 .…”

Hand Surgery in Thailand

“…33 The use of a 3D model of titanium to replace the elbow fracture from Arkaphat Kosiyatrakul and Suriya Luenam 34 from Phramongkutklao Hospital and the distal radius fracture from Woraphoon Jaroenporn and Jaruwat Vechasilp from Police General Hospital. 35…”