Corrective Osteotomy of Malunited Fracture of the Distal end of the Radius

Abstract

Thirty-nine patients with painful impaired forearm rotation and reduced grip strength after malunited fracture of the distal radius were treated with corrective osteotomy of the distal radius, bone grafting and internal fixation and followed for an average of 1.5 years. All patients stated that they were improved by the procedure. At follow-up 36 patients were graded as excellent or good, implying no pain, moderate limitation of motion and grip strength not less than 70% of the uninjured hand. Two patients were graded as fair and one as poor. It is concluded that surgical correction of the deformity is a good procedure when treating disabilities in the distal radio ulnar joint following malunited fractures of the distal end of the radius.

Open Wedge Osteotomy for Malunited Extraarticular Distal Radius Fractures with Plate Osteosynthesis without Bone Grafting

“…Prommersberger et al showed that a minor residual deformity after corrective osteotomy had significantly better results than a bigger residual deformity [18]. However, in most studies of corrective osteotomies in malunited distal radius fractures, the results regarding improvement in wrist motions were better than the anatomic improvements [13,14,16,[19][20][21][22]. The same results were seen in our study.…”

“…The goal of bone grafting is to achieve an exactly shaped wedge to restore the loss in radiologic measurements in two or three dimensions with support of the correction using a plate. A corticocancellous bone graft should give a better stability according to Ekenstam et al [14]. Ring et al showed an even better stability using a cancellous bone graft [15].…”

Corrective osteotomy of the malunited distal radius fracture: use of periosteal bed may reduce the extent of postoperative graft resorption

“…Fernandez [10] did not describe a single complete resorption out of 20 cases, but reported a loss of correction in two patients due to a partial graft collapse. af Ekenstam and co-workers [1] described only one complete resorption in a group of 39 a Cumulative logit model was fitted with adjustment for age, sex, ulnar and palmar tilt and capitate-ulna distance values before surgery and 2-4 days after the surgery. Difference between groups regarding the frequency of "none to mild" outcome is expressed as adjusted odds ratio (OR) with 95% confidence intervals (CI).…”

The radioulnar joint in distal radial fractures: A review

“…The lengthening osteotomy rebalances the load distribution in the wrist, thereby decompressing the ulna abutment. This abutment can also be decompressed by ulnar shortening osteotomies (Milch 1941, Cantero 1977, Geissler et al 1996b), Sauvé-Kapandji arthrodesis of the DRU-joint (Kapandji 1986, Preisser et al 1991, Zilch and additional ligament stabilizing procedures may be necessary in almost half the cases (Posner and Ambrose 1991, Fernandez 1993, Hove and Molster 1994, but af Ekenstam et al (1985) did not nd this advantageous. Since ulnar styloid xation was regarded as a ligament-stabilizing procedure, these contradictory results may be due to recent ndings that the stabilizing ulnoradial ligaments can be torn without fracturing the ulnar styloid (Lindau et al 1997).…”

“…By doing a radial osteotomy with a bone graft (Campbell 1937, Fernandez 1982, af Ekenstam et al 1985, the distal radius can be realigned as regards axial shortening and dorsal angulation. The lengthening osteotomy rebalances the load distribution in the wrist, thereby decompressing the ulna abutment.…”