Distal radius malunion: outcomes following an ulnar shortening osteotomy

Abstract

Purpose Positive ulnar variance following a distal radius malunion can lead to ulnar-sided wrist pain, loss of grip strength, and distal radioulnar joint impingement. The primary aim of this study is to describe upper limb-specific functional outcomes following ulnar shortening osteotomy (USO) for ulnar-sided wrist pain associated with malunion of the distal radius. Methods We retrospectively identified 40 adult patients from a single centre over a 9-year period that had undergone an USO for symptomatic malunion of the distal radius. The primary outcome was the patient-rated wrist evaluation (PRWE). Secondary outcomes were the QuickDASH, EQ-5D-5L, complications, and net promoter score (NPS). Results Outcomes were available for 37 patients (93%). The mean age was 56 years and 25 patients were female (68%). At a mean follow-up of 6 years (range 1–10 years) the median PRWE was 11 (IQR 0–29.5), the median QuickDASH 6.8 (IQR 0–29.5), and the median EQ-5D-5L index was 0.88 (IQR 0.71–1). The NPS was 73. Complications occurred in nine patients (24%) and included non-union (n = 4), early loss of fixation requiring revision surgery (n = 1), superficial wound infection (n = 2), neurological injury (n = 1), and further surgery for symptomatic hardware removal (n = 1). Conclusions For patients with a symptomatic distal radius malunion where the predominant deformity is ulnar positive variance, this study has demonstrated that despite 1 in 4 patients experiencing a complication, USO can result in excellent patient reported outcomes with high levels of satisfaction. Level of Evidence III (Cohort Study).

Wrist Radiographic Indices and Patients’ Performance Following Three Surgical Methods for Management of Distal Radius Fractures: A Randomized Single-Blind Controlled Trial

“…Huddleston et al showed that fixating the radius in -4 mm of ulnar negativity significantly decreased radial translation after sectioning the volar radioulnar ligament and triangular fibrocartilage complex (TFCC) [20]. Similar evidence reported that positive ulnar variance one year after distal radial fracture was clearly associated with unfavorable DASH score and weakness of grip [21,22].…”

Distal radial fractures: a nationwide register study on corrective osteotomies after malunion

“…Although some conservatively treated distal radial fractures result in malunion ( Brogren et al., 2011 ; Katt et al., 2020 ; Ng and McQueen, 2011 ), the incidence of symptomatic malunion is not well reported. When a malunited distal radial fracture with radial shortening leads to symptomatic ulnar impaction causing ulnar pain, an ulnar shortening osteotomy can be considered a treatment choice, but is less common than radial osteotomy ( Hassan et al., 2019 ; Stirling et al., 2023 ; Terzis et al., 2020 ).…”

Patients Prefer Ultrasound to Nerve Conduction Studies for the Diagnosis of Carpal Tunnel Syndrome

“…The NPS or FFT has been used in several orthopedic studies to measure patient satisfaction after a procedure and has been found to be a useful addition to traditional measures of patient satisfaction. 12–19 According to Stirling et al, the FFT correlated well with postoperative hand surgery functional improvement and patient satisfaction. 12 The benefits of using the NPS in healthcare includes ease of use, high completion rates, 13 and being well understood by most patients.…”