Simultaneous radial closing wedge and ulnar shortening osteotomies for distal radius malunion

Corrective Osteotomy for Volarly Malunited Distal Radius Fracture

“…9 -12 Thivaios and McKee 21 further developed sliding osteotomy, and Wada et al 16 described simultaneous radial closing wedge and ulna-shortening osteotomy to avoid use of iliac crest bone graft. Although complications of iliac bone graft including correction loss and recurrent malunion have been reported, 13,14,16 we encountered few complications of corrective osteotomy with iliac bone graft in the treatment of volarly malunited distal radius.…”

“…Final clinical assessment of outcomes was evaluated by modified Mayo wrist score. 18 We also divided patients into a younger group (Յ45 years old; n ϭ 16) and an older group (Ͼ45 years; n ϭ 12) to analyze whether patient age influenced the duration until union of the radius according to Wada et al 16 The split into younger and older groups and use of age 45 years as the cutoff point was based on previous 28 VOLARLY MALUNITED DISTAL RADIUS FRACTURE reports. 15,16 Union periods for both groups were compared.…”

“…13,14 One study indicated that 70% of women aged 45 to 80 years with distal radius fracture showed low bone mass regardless of age. 15 Consequently, Wada et al 16 noted that opening wedge osteotomy might not be suitable for women aged 45 or older.…”

Malunion of the distal radius

“…Having in mind that any angular deformity in the sagittal plane aVects the distal radioulnar joint ulna shortening is only indicated for dorsal malunion with dorsal tilting less than 10° and palmar malunion with less than 20° palmar angulation [41,42]. For malunion with a radial shortening over 12 mm, a combined closed-wedge osteotomy of the radius and ulna shortening should be considered [43].…”

“…If radial lengthening is complicated by soft tissue contracture, complete tenotomy or z-lengthening of the brachioradialis tendon may be helpful [63]. While callotaxis is an useful technique to achieve satisfactory length for young patients with growth arrest, combined radius-ulna osteotomy can be recommended for elderly people [43,64].…”