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

Abstract

Ab stractBackground: Malunion of distal radius fractures can cause pain, limited wrist motion, or loss of grip strength. The most important factors are incongruity in the distal radioulnar (DRU) joint and radial tilt which causes adaptive carpal instability. The purpose of open wedge corrective osteotomy is to restore congruency with minimal soft-tissue damage. Patients and Methods: Between 1993 and 2001, 47 patients with malunited extraarticular distal radius fractures who were treated by open wedge corrective osteotomy without bone grafting were included. The patients were divided into two groups, one group with dorsal tilt of the distal radius and one group with palmar tilt. Ulnar variance, radial inclination, and radial tilt were measured before and after operation. Also, the range of wrist motions was tested before and after correction, including grip strength. Fixation was performed with a dorsal or palmar plate, dependent on the side of radial tilt. Results: Improvement of especially radial tilt was seen in both groups. Also, an important increase in wrist motions was observed. Flexion of the wrist improved by 38.0° in the dorsal group and by 43.0° in the palmar group. With respect to rotation of the lower arm, supination improved most by 21.6° and 46.0° in the dorsal and palmar group, respectively. All osteotomies healed within 3 months without secondary displacement even after a short period of immobilization. Conclusion:Corrective osteotomy is a useful additional therapy in the treatment of malunited extraarticular fractures of the distal radius in which bone grafting is not necessary.

Is Bone Grafting Necessary in the Treatment of Malunited Distal Radius Fractures?

“…The study showed improvement in functional and radiographic outcomes regardless of type of plate fixation and fracture type. 40 These results are also consistent with those of a prospective study in which 22 malunions with dorsal angulation were treated with open wedge osteotomy and volar locked plates without bone grafts. 41 Another study retrospectively evaluated 28 patients with an extra-articular malunion of the distal radius.…”

“…All studies reported no problems with bone healing. [40][41][42][43] The study of Wieland et al was the first published study that retrospectively evaluated 47 extra-articular malunions treated without the use of bone grafts. The study showed improvement in functional and radiographic outcomes regardless of type of plate fixation and fracture type.…”

“…[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Only a few studies have evaluated bone healing after corrective osteotomy and plate fixation without bone grafting. [40][41][42][43] None of these studies reported healing problems. However, these studies included only small numbers of patients.…”

“…However, these studies included only small numbers of patients. [40][41][42][43] Therefore, the purpose of this study was to assess bone healing and secondary fracture displacement after corrective osteotomy and plate fixation without bone grafting in a large patient cohort. We hypothesized that all osteotomies healed within 4 months.…”

Non-union in 3 of 15 osteotomies of the distal radius without bone graft

“…The excellent healing potential of the metaphyseal region of the distal radius ( Prommersberger et al 2002a ) has made the need for a bone graft questionable, and in a series of 35 cases ( Wieland et al 2005 ) and more recently in a series of 22 cases ( Mahmoud et al 2012 ), no non-unions were reported, despite the fact that no bone graft was used.…”