|
1
|
Paul R, Persitz J, Khan S, MacDougall M, Chan A. The Role of Bone Grafting in Corrective Osteotomy of Distal Radius Malunions. J Wrist Surg 2025; 14:184-193. [PMID: 40151780 PMCID: PMC11936707 DOI: 10.1055/s-0044-1787539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/16/2024] [Indexed: 03/29/2025]
Abstract
Background It remains unclear whether bone grafting is required during corrective osteotomy of the distal radius. The goal of this systematic review is to determine the union, revision, and complication rates of bone grafting techniques associated with extra-articular corrective osteotomy for dorsally malunited distal radius fractures treated with volar plating. Questions Is bone grafting in distal radius corrective osteotomy associated with increased rates of bone union and reduced rates of revision surgery and complications? Materials and Methods A comprehensive search of the MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature databases was completed for studies reporting clinical outcomes of extra-articular corrective osteotomy for dorsally malunited distal radius fractures treated with volar plating. Results A total of 13 studies, with 14 intervention arms and 236 patients, were included. Bone grafting techniques consisted of autograft (6 studies, n = 93), synthetic bone grafts (2 studies, n = 38), allograft (1 study, n = 14), or no grafting (5 studies, n = 91). The overall union rate was 97%, and the mean time-to-union was 12.0 weeks. Larger corrections of dorsal tilt and ulnar variance were performed in the autograft and allograft groups. Complication and revision rates were highest in the synthetic group, 45 and 26.3% respectively. Conclusion Grafting in extra-articular corrective osteotomy for dorsally angulated distal radius malunions treated with volar plating is not associated with an improved union rate in the literature. However, larger corrections were achieved in both the autograft and allograft groups compared to the no-graft and synthetic groups, resulting in similar union rates. Synthetic bone grafting was associated with the highest complication and revision rates. Future comparative prospective trials and proper documentation of whether cortical contact was present or absent are required to assess whether bone grafting warrants consideration in more advanced deformities. Level of Evidence IV.
Collapse
Affiliation(s)
- Ryan Paul
- Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Persitz
- Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shawn Khan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael MacDougall
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Chan
- Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
|
2
|
Sondur S, Bhat AK, Bhat N S. Clinical and Radiographic Outcomes of Gap Osteotomy Versus Dorsal Opening Wedge Osteotomy for Extra-Articular Distal Radius Malunion and Internal Fixation Using a Volar Locking Plate Without Bone Graft. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2025; 7:14-22. [PMID: 39991604 PMCID: PMC11846579 DOI: 10.1016/j.jhsg.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Accepted: 09/04/2024] [Indexed: 02/25/2025] Open
Abstract
Purpose Metaphyseal corrective osteotomy and fixed-angle volar locking plate fixation have reduced the need for additional bone grafting in symptomatic distal radius malunions. This study evaluated the outcomes of gap versus dorsal opening wedge and locking plate fixation without bone grafts for distal radius malunions and the correlation between the osteotomy defect and the osteotomy's distance from the articular surface with the union time. Methods We retrospectively reviewed 62 patients who underwent corrective osteotomy between 2010 and 2021. Gap osteotomy (n = 44) was performed to correct the coronal deformity predominantly, whereas an opening wedge osteotomy (n = 18) was performed to correct the sagittal deformity. No bone graft was used in any patient. Radiological outcomes comprised of correction of radial height, inclination, ulnar variance, volar tilt and the correlation between the osteotomy defect and the distance from the distal radial articular surface with the union time. The functional assessment comprised the disabilities of arm, shoulder, and hand questionnaire and the patient-rated wrist evaluation scores. Results All patients had a union of the osteotomy and statistically significant improvement in the radial height, inclination, ulnar variance, and tilt, irrespective of the osteotomy technique (P < .05). The mean defect length of the osteotomy, the time to the union, and the distance of the osteotomy were 4.7 mm (1-8.3 mm), 11.7 weeks (5-24 weeks), and 13.9 mm (1.6-35.8 mm), respectively. Time taken for union showed a weak positive correlation with the defect length of the osteotomy and no correlation with the distance of the distal osteotomy site from the articular surface. Opening wedge osteotomies took less time than the gap osteotomies. The mean postoperative disabilities of arm, shoulder, and hand questionnaire and the patient-rated wrist evaluation scores were 6.89 and 12.18, respectively. Conclusions Corrective osteotomy and fixed-angle volar plate fixation for distal radius malunion provide satisfactory union rates and clinical and radiological outcomes even without bone graft, irrespective of the osteotomy type, size, or location. However, length of the osteotomy defect influenced the union time. Type of study/level of evidence Therapeutic IV.
Collapse
Affiliation(s)
- Suhas Sondur
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Anil K. Bhat
- Department of Hand Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Shyamasunder Bhat N
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
|
3
|
Haines SC, Bott A. Current Concepts: Corrective Osteotomy for Extra-Articular Deformity Following a Distal Radius Fracture. Cureus 2023; 15:e47019. [PMID: 37965406 PMCID: PMC10642188 DOI: 10.7759/cureus.47019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 11/16/2023] Open
Abstract
Fracture malunion alters wrist and distal radioulnar joint (DRUJ) biomechanics, resulting in incongruence and instability of the DRUJ. Selected patients with painful functional limitation and significant deformity of the radius, but without advanced degenerative joint disease, may benefit from corrective distal radial osteotomy. Non-union and complications arising from metalwork are the most common reasons for reoperation. Surgeons should have a good understanding of risks and complications in order to fully inform their patients and manage expectations. This article reviews the biomechanical effects of radial malunion and the current concepts for treatment. Distal radial osteotomy is suitable for symptomatic patients with angular radial deformity and shortening. Evidence supports a volar approach without bone grafts for modest corrections. Bone grafts or synthetic bone substitutes are appropriate for larger corrections. Functional improvements are reported regardless of technique. Despite a high complication rate, patient satisfaction with the corrective radial osteotomy is high.
Collapse
Affiliation(s)
- Samuel C Haines
- Trauma and Orthopaedics, Bristol Royal Infirmary, Bristol, GBR
| | - Alasdair Bott
- Trauma and Orthopaedics, Southmead Hospital, Bristol, GBR
| |
Collapse
|
|
4
|
Gouk C, Bairstow M, Thomas M, Tan E, Taylor F, Bindra R. A comparison of early fixation of distal radius fractures versus late corrective osteotomy of distal radius malunion. ANZ J Surg 2022; 92:3319-3324. [PMID: 36259218 PMCID: PMC10091807 DOI: 10.1111/ans.18122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/23/2022] [Accepted: 10/05/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Fractures of the distal radius are common. Closed reduction and moulded casting is often the first line treatment. Malunion after casting is not uncommon and can lead to discussion on acute surgical fixation versus delayed corrective osteotomy if symptomatic. However, it is unclear if late surgery will provide similar outcomes as early intervention. METHODS We performed a single centre, age matched, case series comparison study, comparing outcomes of patients who had undergone early fixation (ORIF) versus those who had undergone late corrective osteotomy (CO) following distal radius fracture. RESULTS Twenty-six patients were available for review, 13 in each group. Fracture patterns were similar. Reviewing CO versus ORIF; patients achieved a mean DASH; 22 versus 18 (P = 0.355), PRWE; 35 versus 26 (P = 0.237), and VAS 2 versus 2 (P = 0.490). Grip strength was significantly better in those who had undergone ORIF; 2% versus -22% (P ≤ 0.001). Range of motion was generally better with primary fixation but of doubtful clinical importance, reviewing CO versus ORIF; Flexion 46° versus 60° (P = 0.045), extension 55° versus 64° (P = 0.137), pronation 73° versus 85° (P = 0.078), supination 84° versus 84° (P = 0.747), flexion/extension arc 101 versus 124 (P = 0.017), ulnar/radial deviation arc 42° versus 59° (P = 0.01), pronation/supination arc 157° versus 168° (P = 0.118). Ulnar variance was significantly improved in the ORIF group; +0.5 mm versus +2 mm in the CO group (P = 0.023). Radial inclination, radial height and volar tilt were not significantly different between either group. CONCLUSION Our findings suggest that patient measured outcome of corrective osteotomy is not inferior to early internal fixation. LEVEL OF EVIDENCE III (Case Series Comparison).
Collapse
Affiliation(s)
- Conor Gouk
- Department of Trauma and Orthopaedics, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Department of Orthopaedics, Griffith University, Gold Coast, Queensland, Australia
| | - Melissa Bairstow
- Department of Trauma and Orthopaedics, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Department of Orthopaedics, Griffith University, Gold Coast, Queensland, Australia
| | - Michael Thomas
- Department of Trauma and Orthopaedics, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Department of Orthopaedics, Griffith University, Gold Coast, Queensland, Australia
| | - Ezekiel Tan
- Department of Trauma and Orthopaedics, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Department of Orthopaedics, Griffith University, Gold Coast, Queensland, Australia
| | - Fraser Taylor
- Department of Trauma and Orthopaedics, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Department of Orthopaedics, Griffith University, Gold Coast, Queensland, Australia
| | - Randy Bindra
- Department of Trauma and Orthopaedics, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Department of Orthopaedics, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
|
5
|
Izmalkov SN, Semenkin OM, Bratiichuk AN. Corrective Osteotomy of Malunited Fractures of the Distal Radius Using a Combined Surgical Approach. Hand (N Y) 2022; 17:740-747. [PMID: 32686500 PMCID: PMC9274874 DOI: 10.1177/1558944720939199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Malunited distal radius (DR) fractures following conservative treatment range from 6% to 80% of clinical observations. Surgical treatment is used to return the articular surface of the radius to original anatomical position and to restore the natural transfer of strength, wrist kinematics, and function of the entire hand. The aim of this research was to study and analyze the results of corrective osteotomy of malunited distal radius fractures using a combined approach. Methods: From 2008 to 2018, 43 patients with malunited DR fractures who underwent surgery using a combined approach were followed up. Long-term results (1 year after surgery) were studied in detail in 32 patients. Indications for surgery were determined taking into account, first, complaints of severe pain in the wrist during exertion, decreased hand strength, and limited mobility of the wrist. Results: Five patients (15.6%) reported a number of minor complications: intra-articular screw placement (2), incorrect reposition (1), transient neuropathy of the superficial branch of the radial nerve (1), and delayed fracture consolidation (1). In addition, another 5 patients reported the progression of wrist arthritis. Suppurations of the surgical wound and malunited fragments were not reported. Conclusions: During reconstructive interventions, a combined approach with palmar plating provides optimal conditions for corrective osteotomy, adequate reposition and plastic repair of the bone defect, and minimization of the number of complications.
Collapse
Affiliation(s)
| | - Oleg M. Semenkin
- Samara Regional Clinical Hospital named after V.D. Seredavin, Russian Federation
| | - Aleksandr N. Bratiichuk
- Samara State Medical University, Russian Federation,Aleksandr N. Bratiichuk, Department of Traumatology, Orthopaedics and Outpatient Surgery, Samara State Medical University, 89 Chapaevskaya Street, Samara 443099, Russian Federation.
| |
Collapse
|
|
6
|
Bhatia N, Gupta A, Dabas V, Kataria A, Goel A, Yadav A. Z-Corrective Osteotomy in Malunited Extra-Articular Fractures of Distal Radius. J Hand Surg Am 2022; 47:585.e1-585.e10. [PMID: 34420837 DOI: 10.1016/j.jhsa.2021.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/25/2021] [Accepted: 06/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We sought to assess clinical, radiological, and functional outcomes following treatment of extra-articular malunions of the distal radius using a multiplanar z-corrective osteotomy. METHODS Fifteen patients with extra-articular distal radius malunions (13 dorsal and 2 volar) underwent z-corrective osteotomy and volar plate fixation without bone grafting. Correction and maintenance of each deformity was evaluated in terms of various radiographic indices (radial height; volar and radial tilt); osteotomy union; pain (visual analog scale); grip strength; range of motion; Disabilities of the Arm, Shoulder, and Hand scores; and Mayo wrist scores. RESULTS The mean follow-up was 16.4 months. The mean radial height was corrected from -1.3 mm to 4.9 mm. The mean ulnar variance improved from 4.3 mm to -0.4 mm. The sagittal radial tilt and radial inclination were restored from a mean of -17.9° (dorsal) to 3.3° (volar) and from 12.0° to 17.2°, respectively. The Disabilities of the Arm, Shoulder, and Hand and Mayo wrist scores improved from means of 36 and 56 preoperatively to 24.8 and 73.3, respectively, at 6 months and further to 20.6 and 77.6, respectively, at the last follow-up. There were no nonunions or tendon-related problems. The mean pain score decreased from 4.1 preoperatively to 1.0 at 6 months and 0.8 at the last follow-up. The mean grip strength improved from 5.6 kg preoperatively to 15.6 kg at 6 months and 19.7 kg at the last follow-up. There was a statistically significant improvement in range of motion at the wrist. CONCLUSIONS The z-osteotomy provides correction of deformity in all 3 planes, along with restoration of radial height. It also maintains a broad area of bone contact between the 2 osteotomized bone fragments, facilitating bony union and eliminating the need for bone grafting. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Nishant Bhatia
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Ajay Gupta
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Vineet Dabas
- Department of Orthopaedic Surgery, Lady Hardinge Medical College and Associated SSK & KSC Hospitals, Connaught Place, New Delhi, India
| | - Ankit Kataria
- Department of Orthopaedics, Government Institute of Medical Sciences, Greater Noida, UP, India
| | - Akash Goel
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.
| | - Akash Yadav
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| |
Collapse
|
|
7
|
Leti Acciaro A, Garagnani L, Lando M, Cataldo G, Adani R. Retrospective study of radial dome osteotomy with volar plate fixation versus K-wires in Madelung's deformity: long-term follow-up. INTERNATIONAL ORTHOPAEDICS 2021; 46:281-289. [PMID: 34850246 DOI: 10.1007/s00264-021-05266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The emerging role of the locking plate improved the technique also in corrective osteotomies in Madelung's deformity, but there is a lack of analyses between the fixation techniques, as well as little information in functional outcomes and long-term follow-up. The current study compared the outcomes, pitfalls, and advantages of volar plate and screws fixation versus K-wires fixation in a long-term follow-up. METHODS Twenty-eight children presenting the "distal radius" variant of Madelung's deformity underwent Vickers ligament release and distal radial dome osteotomy between 2009 and 2015. Twenty-three children (20 females and 3 males, mean age 15 years and 7 months at surgery and 24 years and 8 moths at follow-up), with 26 operatively treated wrists, were available for follow-up. A retrospective two-cohort study, evaluating clinically and radiologically results, has been conducted with a mean eight years and seven months follow-up. RESULTS Bone union and pain relief were obtained in all cases, as well as improvements in wrist motion and radiographic indices. A statistically significant correlation was identified between the volar plate fixation and an improved lunate subsidence on X-ray, and a trend towards an improved DASH score in the cohort with plate and screws, as well as significant improvement in wrist extension and supination always in the plate fixation cohort. CONCLUSIONS The long-term follow-up enabled the patients to report on more definitive outcomes in terms of functional and cosmetic improvements. Volar plate fixation is an effective technique allowing for simple post-operative management and earlier rehabilitation program with improved clinical and radiographic outcomes.
Collapse
Affiliation(s)
- Andrea Leti Acciaro
- Department of Hand Surgery and Microsurgery, AOU Policlinico, L.go del Pozzo, 71, 41124, Modena, Italy.
| | - Lorenzo Garagnani
- Hand Unit/Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mario Lando
- Department of Hand Surgery and Microsurgery, AOU Policlinico, L.go del Pozzo, 71, 41124, Modena, Italy
| | - Giacomo Cataldo
- Department of Orthopaedic and Traumatology, University of Modena and Reggio Emilia, AOU Policlinico, Modena, Italy
| | - Roberto Adani
- Department of Hand Surgery and Microsurgery, AOU Policlinico, L.go del Pozzo, 71, 41124, Modena, Italy
| |
Collapse
|
|
8
|
Leti Acciaro A, Garagnani L, Lando M, Lana D, Sartini S, Adani R. Modified dome osteotomy and anterior locking plate fixation for distal radius variant of Madelung deformity: a retrospective study. J Plast Surg Hand Surg 2021; 56:121-126. [PMID: 34106811 DOI: 10.1080/2000656x.2021.1934845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Dome osteotomy of the distal radius with Vickers ligament release is an established method of treatment for Madelung deformity. Many different surgical procedures have been proposed in literature but techniques, patient inclusion and efficacy evaluations are heterogeneous. MATERIALS AND METHODS A retrospective review of children affected by 'distal radius' Madelung deformity and treated with a standardized surgical procedure (modified reverse dome osteotomy of the distal radius and volar fixation with a small locking plate) between 2010 and 2018 at a single center was performed. The technique used in this study, reversing the shape of the classical dome osteotomy, allowed for an improved three-planar correction of the distal radial epiphysis and volar plate fixation allowed for an increased stability and reduced soft tissue morbidity. A structured follow-up including a prompt post-operative rehabilitation program (without wrist immobilization) was established. Pain relief, functional outcome and cosmetic appearance were assessed with a structured clinical assessment, DASH Score and radiographic assessment, accordingly. RESULTS A total of 15 wrists in 13 children (12 females, mean age of 15.6 years, range 11-19) were included. The mean follow-up time was 3.8 years. Bone union and pain relief were obtained in all cases. Improvement in the range of motion was detected in extension, supination and flexion of the wrist. Radial inclination was increased by 15.3° and lunate subsidence by 4.1 mm. CONCLUSIONS The use of volar fixation with a small locking plate and immediate post-operative rehabilitation for reverse dome osteotomy of the distal radius in pediatric patients affected by 'distal radius' Madelung's deformity is stable and effective.
Collapse
Affiliation(s)
- Andrea Leti Acciaro
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Lorenzo Garagnani
- Hand Unit/Department of Orthopedics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mario Lando
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Debora Lana
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Silvana Sartini
- Hand Rehabilitation Unit, University Hospital of Modena, Modena, Italy
| | - Roberto Adani
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| |
Collapse
|
|
9
|
The Dorsal Periosteal Curtain for Distal Radius Osteotomy Via the Volar Approach. Tech Hand Up Extrem Surg 2020; 25:183-187. [PMID: 33264258 DOI: 10.1097/bth.0000000000000329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Volar wedge osteotomy and angle stable volar plating is now considered a standard approach for correction of distal radius malunion. In previous descriptions of the technique, soft tissue release has been performed with periosteal incision in line with the bony osteotomy. We present a technique whereby the dorsal periosteum is incised more proximally creating a dorsal vascularized periosteal "curtain." Our technique has several advantages including systematic release of restraining soft tissues to allow better distraction and reduction of the malunion; a dorsal periosteal curtain of vascular tissue with which to contain bone graft, protect extensor tendons and expedite healing; and better access to locally available bone graft. The previously described rotation-advancement of pronator quadratus is also used for plate coverage. We have found this technique straightforward to execute and teach, and useful in mitigating against some of the potential risks of the standard technique.
Collapse
|
|
10
|
Stirling PHC, Oliver WM, Ling Tan H, Brown IDM, Oliver CW, McQueen MM, Molyneux SG, Duckworth AD. Patient-reported outcomes after corrective osteotomy for a symptomatic malunion of the distal radius. Bone Joint J 2020; 102-B:1542-1548. [PMID: 33135431 DOI: 10.1302/0301-620x.102b11.bjj-2020-0848.r3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The primary aim of this study was to describe patient satisfaction and health-related quality of life (HRQoL) following corrective osteotomy for a symptomatic malunion of the distal radius. METHODS We retrospectively identified 122 adult patients from a single centre over an eight-year period who had undergone corrective osteotomy for a symptomatic malunion of the distal radius. The primary long-term outcome was the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcomes included the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, the EQ-5D-5L score, complications, and the Net Promoter Score (NPS). Multivariate regression analysis was used to determine factors associated with the PRWE score. RESULTS Long-term outcomes were available for 89 patients (72%). The mean age was 57 years (SD 15) and 68 were female (76%). The median time from injury to corrective osteotomy was nine months (interquartile range (IQR) 6 to 13). At a mean follow-up of six years (1 to 11) the median PRWE score was 22 (IQR 7 to 40), the median QuickDASH score was 11.4 (IQR 2.3 to 31.8), and the median EQ-5D-5L score was 0.84 (IQR 0.69 to 1). The NPS was 69. Multivariate regression analysis showed that the presence of an associated ulnar styloid fracture was the only significant independent factor associated with a worse PRWE score when adjusting for confounding variables (p = 0.004). CONCLUSION We found that corrective osteotomy for malunion of the distal radius can result in good functional outcomes and high levels of patient satisfaction. However, the presence of an ulnar styloid fracture may adversely affect function. Level of Evidence: III (cohort study). Cite this article: Bone Joint J 2020;102-B(11):1542-1548.
Collapse
Affiliation(s)
- Paul H C Stirling
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William M Oliver
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Huai Ling Tan
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Iain D M Brown
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Christopher W Oliver
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Margaret M McQueen
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | - Sam G Molyneux
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew D Duckworth
- Edinburgh Orthopaedics - Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| |
Collapse
|
|
11
|
Corrective Osteotomy of Distal Radius Malunion Using a Rectangular-shaped Iliac Bone Graft and Volar Plating. Tech Hand Up Extrem Surg 2020; 25:130-135. [PMID: 33122494 DOI: 10.1097/bth.0000000000000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Distal radius fractures are one of the most common injuries seen by orthopedists at the emergency room and clinics. Severity and configuration may vary, and therapeutic options are broad, but regardless of the course of treatment, all cases can potentially lead to malunion. When malunion requires surgical correction, the surgery can be technically demanding. Here, we demonstrate an alternative technique to perform corrective osteotomies for extra-articular or minimally displaced articular distal radius malunion. We provide simplification of the procedure by eliminating one of the planes taken into consideration when performing an osteotomy. This technique includes the use of a tricortical iliac bone graft, which we feel, provides dependable structural support, preventing collapse. The technique allows the surgeon an easy means to access the osteotomy gap and apply the graft. Finally, we supplement this surgical technique by providing our outcomes. Our data suggest that the technique effectively restores radiographic wrist parameters and provides good union rates.
Collapse
|
|
12
|
Caiti G, Dobbe JGG, Strackee SD, Strijkers GJ, Streekstra GJ. Computer-Assisted Techniques in Corrective Distal Radius Osteotomy Procedures. IEEE Rev Biomed Eng 2020; 13:233-247. [DOI: 10.1109/rbme.2019.2928424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
|
13
|
Haghverdian JC, Hsu JWY, Harness NG. Complications of Corrective Osteotomies for Extra-Articular Distal Radius Malunion. J Hand Surg Am 2019; 44:987.e1-987.e9. [PMID: 30733100 DOI: 10.1016/j.jhsa.2018.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/06/2018] [Accepted: 12/10/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Osteotomy of the distal radius for a fracture malunion is a challenging procedure. The purpose of this study was to review a series of osteotomies to determine the type and risk of complications. METHODS A retrospective cohort study was performed, including all Kaiser Permanente Southern California patients who were aged 18 years or older between January 1, 2007, and September 25, 2015, and underwent osteotomy for an extra-articular distal radius fracture malunion. Charts were reviewed for demographic data, comorbidities, osteotomy type (hinged vs distraction), implant, and bone graft type. Complications including infection, nonunion, loss of reduction, implant failure, nerve injury, tendon injury, and complex regional pain syndrome were recorded. RESULTS There were 60 patients who underwent extra-articular osteotomy of the distal radius for malunion during the study period. The mean age was 54 years (range, 21-83 years). There were 24 distraction-type (intervening bone graft) and 36 hinge-type (volar cortical contact maintained) osteotomies. Twenty-five of 60 patients had complications related to the procedure requiring 13 subsequent procedures. There were 7 nonunions and 3 cases of delayed healing at the osteotomy site. One extensor carpi radialis longus tendon laceration resulted from the use of an osteotome. There were 3 delayed extensor pollicis longus (EPL) tendon ruptures after surgery. The distraction-type osteotomy was associated with a greater risk of major complications including nonunion and delayed union. CONCLUSIONS A complication rate of nearly 50% was observed in distal radius osteotomies. Surgeons should be aware of the risk of injury to, or delayed rupture of the EPL tendon associated with these procedures. The risk of nonunion or delayed union is higher in distraction-type compared with hinge-type osteotomies. Low surgeon volume with this procedure may be a contributing factor to the high rate of complications. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Justin C Haghverdian
- Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Jin-Wen Y Hsu
- Department of Research & Evaluation, Southern California Permanente Medical Group, Pasadena, CA
| | - Neil G Harness
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Anaheim, CA.
| |
Collapse
|
|
14
|
Bytyqi C, Qorraj H, Tolaj A, Hajdari R. Corrective osteotomy of distal radius malunion after IIIB open fracture: Palmar approach - Case report. Int J Surg Case Rep 2019; 58:193-197. [PMID: 31075701 PMCID: PMC6510939 DOI: 10.1016/j.ijscr.2019.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/27/2019] [Accepted: 04/08/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite the fact that distal radius fractures are the most common, open fractures are relatively uncommon. The aim of this study is to present the case with severe malunion of extra-articular left distal radius after open fracture grade IIIB (Gustillo). The treatment was done with open correctuve osteotomy and ostosynthesis with volar low profile plate. CASE PRESENTATION A 32-years old man was admitted to our departement because of severely malunited left distal radius extra-articular metaphyseal fracture after treatment of an open fracture. He was primary treated in a Regional Hospital with irrigation, debridement, antimicrobial cover, and immediate skeletal management through fixation with Kirschner's wires. No external fixator was used. He developed volar metaphyseal angulation after loss of primary reduction of K-wires fixation; therefore it required corrective surgical treatment. Because of malunion, open corrective osteotomy and bone grafting of distal radius with volar plating were done. Follow-up 20 months after surgery show deformity correction of radial volar inclination, height, and restitution of distal radioulnar joint. CONCLUSION This case report offers an informative overview on this uncommon case of distal radius open fracture malunion treated successfully with volar approach corrective osteotomy. Corrective surgery is the primary therapy of choice in the this case. This method have shown to be safe and effective in treatment of distal radius malunion with volar angulation.
Collapse
Affiliation(s)
- Cen Bytyqi
- Medical Faculty, University of Prishtina "Hasan Prishtina", Kosovo; University Clinical Center of Kosovo, Orthopedic Department, Kosovo.
| | - Hasime Qorraj
- Medical Faculty, University of Prishtina "Hasan Prishtina", Kosovo.
| | - Arber Tolaj
- University Clinical Center of Kosovo, Orthopedic Department, Kosovo.
| | | |
Collapse
|
|
15
|
Caiti G, Dobbe JGG, Bervoets E, Beerens M, Strackee SD, Strijkers GJ, Streekstra GJ. Biomechanical considerations in the design of patient-specific fixation plates for the distal radius. Med Biol Eng Comput 2018; 57:1099-1107. [PMID: 30588576 PMCID: PMC6477011 DOI: 10.1007/s11517-018-1945-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/10/2018] [Indexed: 01/08/2023]
Abstract
Use of patient-specific fixation plates is promising in corrective osteotomy of the distal radius. So far, custom plates were mostly shaped to closely fit onto the bone surface and ensure accurate positioning of bone segments, however, without considering the biomechanical needs for bone healing. In this study, we investigated how custom plates can be optimized to stimulate callus formation under daily loading conditions. We calculated implant stress distributions, axial screw forces, and interfragmentary strains via finite element analysis (FEA) and compared these parameters for a corrective distal radius osteotomy model fixated by standard and custom plates. We then evaluated these parameters in a modified custom plate design with alternative screw configuration, plate size, and thickness on 5 radii models. Compared to initial design, in the modified custom plate, the maximum stress was reduced, especially under torsional load (- 31%). Under bending load, implants with 1.9-mm thickness induced an average strain (median = 2.14%, IQR = 0.2) in the recommended range (2-10%) to promote callus formation. Optimizing the plate shape, width, and thickness in order to keep the fixation stable while guaranteeing sufficient strain to enhance callus formation can be considered as a design criteria for future, less invasive, custom distal radius plates. Graphical abstract ᅟ.
Collapse
Affiliation(s)
- G Caiti
- Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands.
| | - J G G Dobbe
- Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
| | - E Bervoets
- Metrotech Engineering & Physics, Begtrupvej 75, Sporup, Denmark
| | - M Beerens
- Xilloc Medical B. V., Urmonderbaan 22, Geleen, Netherlands
| | - S D Strackee
- Amsterdam UMC, University of Amsterdam, Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
| | - G J Strijkers
- Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
| | - G J Streekstra
- Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
| |
Collapse
|
|
16
|
Implementation of a semiautomatic method to design patient-specific instruments for corrective osteotomy of the radius. Int J Comput Assist Radiol Surg 2018; 14:829-840. [PMID: 30535827 DOI: 10.1007/s11548-018-1896-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE 3D-printed patient-specific instruments (PSIs), such as surgical guides and implants, show great promise for accurate navigation in surgical correction of post-traumatic deformities of the distal radius. However, existing costs of computer-aided design and manufacturing process prevent everyday surgical use. In this paper, we propose an innovative semiautomatic methodology to streamline the PSIs design. METHODS The new method was implemented as an extension of our existing 3D planning software. It facilitates the design of a regular and smooth implant and a companion guide starting from a user-selected surface on the affected bone. We evaluated the software by designing PSIs starting from preoperative virtual 3D plans of five patients previously treated at our institute for corrective osteotomy. We repeated the design for the same cases also with commercially available software, with and without dedicated customization. We measured design time and tracked user activity during the design process of implants, guides and subsequent modifications. RESULTS All the designed shapes were considered valid. Median design times ([Formula: see text]) were reduced for implants (([Formula: see text]) = 2.2 min) and guides (([Formula: see text]) = 1.0 min) compared to the standard (([Formula: see text]) = 13 min and ([Formula: see text]) = 8 min) and the partially customized (([Formula: see text]) = 6.5 min and ([Formula: see text]) = 6.0 min) commercially available alternatives. Mouse and keyboard activities were reduced (median count of strokes and clicks during implant design (([Formula: see text]) = 53, and guide design (([Formula: see text]) = 27) compared to using standard software (([Formula: see text]) = 559 and ([Formula: see text]) = 380) and customized commercial software (([Formula: see text]) = 217 and ([Formula: see text]) = 180). CONCLUSION Our software solution efficiently streamlines the design of PSIs for distal radius malunion. It represents a first step in making 3D-printed PSIs technology more accessible.
Collapse
|
|
17
|
Mugnai R, Tarallo L, Lancellotti E, Zambianchi F, Di Giovine E, Catani F, Adani R. Corrective osteotomies of the radius: Grafting or not? World J Orthop 2016; 7:128-135. [PMID: 26925385 PMCID: PMC4757658 DOI: 10.5312/wjo.v7.i2.128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 10/03/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the current literature regarding corrective osteotomies to provide the best evidence of the rule of bone grafting.
METHODS: Our MEDLINE literature search included 280 studies using the following key words “Malunited distal radius fracture” and 150 studies using key words “Corrective osteotomy of the distal radius”. Inclusion criteria were: Malunited distal radial, extra articular fracture, volar locking plate, use of iliac bone graft (cancellous or corticocancellous), non-use of bone graft. Twelve studies met the inclusion criteria.
RESULTS: Seven of the 12 studies considered, described the use of a graft; the remaining five studies didn’t use any graft. Type of malunion was dorsal in most of the studies. The healing time was comparable using the graft or not (mean 12.5 wk), ranging from 7.5 to 16 wk. The mean disabilities of the arm, shoulder and hand score improvement was 23 points both in the studies that used the graft and in those not using the graft.
CONCLUSION: This review demonstrated that corrective osteotomy of extra-articular malunited fractures of the distal radius treated by volar locking plate does not necessarily require bone graft.
Collapse
|
|
18
|
Fok MWM, Fernandez DL, Rivera YLH. A less invasive distal osteotomy of the radius for malunited dorsally displaced extra-articular fractures. J Hand Surg Eur Vol 2015; 40:812-8. [PMID: 25261410 DOI: 10.1177/1753193414551910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/21/2014] [Indexed: 02/03/2023]
Abstract
A less invasive corrective osteotomy for symptomatic post-traumatic deformity of the distal radius was done in 12 patients. They were followed up for an average of 3.7 years. The indications for correction were based on the patients' level of activities, pain, functional limitations, loss of grip strength or deformity occurring with an extra-articular rotational malunion of the distal end of the radius. The procedure included a dorsal open wedge osteotomy through a dorsal incision in which the fulcrum of rotation, or hinge, was located at the palmar cortex, and stabilized with an extra- and intramedullary fixed angle device. The bone defect was replaced with autologous morsellized iliac bone graft. The final outcome was graded as very good in eight patients, good in two and fair in two. Level of evidence: IV.
Collapse
Affiliation(s)
- M W M Fok
- Department of Orthopaedic Surgery, Lindenhof Hospital, Bern, Switzerland
| | - D L Fernandez
- Department of Orthopaedic Surgery, Lindenhof Hospital, Bern, Switzerland
| | | |
Collapse
|
|
19
|
Disseldorp DJG, Poeze M, Hannemann PFW, Brink PRG. Is Bone Grafting Necessary in the Treatment of Malunited Distal Radius Fractures? J Wrist Surg 2015; 4:207-213. [PMID: 26261748 PMCID: PMC4530180 DOI: 10.1055/s-0035-1558831] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Open wedge osteotomy with bone grafting and plate fixation is the standard procedure for the correction of malunited distal radius fractures. Bone grafts are used to increase structural stability and to enhance new bone formation. However, bone grafts are also associated with donor site morbidity, delayed union at bone-graft interfaces, size mismatch between graft and osteotomy defect, and additional operation time. Purpose The goal of this study was to assess bone healing and secondary fracture displacement in the treatment of malunited distal radius fractures without the use of bone grafting. Methods Between January 1993 and December 2013, 132 corrective osteotomies and plate fixations without bone grafting were performed for malunited distal radius fractures. The minimum follow-up time was 12 months. Primary study outcomes were time to complete bone healing and secondary fracture displacement. Preoperative and postoperative radiographs during follow-up were compared with each other, as well as with radiographs of the uninjured side. Results All 132 osteotomies healed. In two cases (1.5%), healing took more than 4 months, but reinterventions were not necessary. No cases of secondary fracture displacement or hardware failure were observed. Significant improvements in all radiographic parameters were shown after corrective osteotomy and plate fixation. Conclusion This study shows that bone grafts are not required for bone healing and prevention of secondary fracture displacement after corrective osteotomy and plate fixation of malunited distal radius fractures. Level of evidence Therapeutic, level IV, case series with no comparison group.
Collapse
Affiliation(s)
- Dominique J. G. Disseldorp
- Department of General Surgery and Traumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martijn Poeze
- Department of General Surgery and Traumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Pascal F. W. Hannemann
- Department of General Surgery and Traumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Peter R. G. Brink
- Department of General Surgery and Traumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
|
20
|
Tarallo L, Mugnai R, Adani R, Catani F. Malunited extra-articular distal radius fractures: corrective osteotomies using volar locking plate. J Orthop Traumatol 2014; 15:285-90. [PMID: 25017024 PMCID: PMC4244554 DOI: 10.1007/s10195-014-0307-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 06/20/2014] [Indexed: 12/24/2022] Open
Abstract
Background Multiple techniques for corrective osteotomy have been developed in recent years with the same aims: to improve the radiographic parameters and improve motion, pain and grip strength. Volar fixed-angle plates have added a new concept to the treatment of distal radius fractures thanks to the low morbidity of the surgical approach and the strength of the final construct, allowing early mobilization and return to function. Materials and methods Between 2005 and 2012, 20 patients with symptomatic dorsally malunited extra-articular fractures of the distal radius underwent corrective osteotomy using a volar locking plate without additional bone graft. At a mean follow-up of 50 months, all the patients were clinically and functionally evaluated. Results All measurements of pain, final range of motion and grip strength significantly improved compared with preoperative measurements. The mean preoperative DASH score reduced from 54 points preoperatively to 25 postoperatively. Based on the modified Mayo wrist score, we obtained 14 excellent and six good results. Palmar tilt improved from an average of 23° to 11°. Radial inclination improved from an average of 29° to 22°, and ulnar variance decreased from an average of 3.6 mm to 0.9 mm. There were two cases of transient median neuroapraxia that resolved before the 6-week follow-up appointment. No other major complications, including non-union and infection, were observed. Conclusion The volar approach and locking plate, without necessarily the use of bone grafting, proved to be an effective approach for addressing symptomatic and even severe deformities of the distal radius. Type of study/level of evidence Therapeutic IV
Collapse
Affiliation(s)
- Luigi Tarallo
- Department of Orthopaedic Surgery, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy,
| | | | | | | |
Collapse
|
|
21
|
Opel S, Konan S, Sorene E. Corrective distal radius osteotomy following fracture malunion using a fixed-angle volar locking plate. J Hand Surg Eur Vol 2014; 39:431-5. [PMID: 24051477 DOI: 10.1177/1753193413497636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Post-traumatic distal radius deformity may cause severe morbidity, and corrective osteotomy is often necessary to realign the functional axis of the wrist to correct symptomatic malunion. The aim of this retrospective study was to review the short-term results of a single surgeon’s series of distalradius corrective osteotomies following fracture malunion using a fixed-angle volar locking plate for 20 patients(16 women) of an average age of 57 (range 19–83) years [corrected].At short-term follow up (average 14 months, range 12-15 months), no complications were noted and radiological union was confirmed in all cases at an average of 3 months. The average post-operative Disability of the Arm, Shoulder and Hand score was 13.48 (range 0-48.33) and an objective improvement was noted in movements at the wrist joint. A statistically significant improvement was achieved in ulnar variance, radial inclination, dorsal tilt, and supination.
Collapse
Affiliation(s)
- S Opel
- Department of Trauma and Orthopaedics, University College Hospital, London, UK
| | | | | |
Collapse
|
|
22
|
Correction of extra-articular distal radius malunions using an anatomic radial plate. Tech Hand Up Extrem Surg 2013; 17:162-8. [PMID: 23970199 DOI: 10.1097/bth.0b013e318299c7c1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Malunion is a debilitating complication of a distal radius fracture. The malunion often requires a corrective osteotomy to restore the stability and joint congruity about the distal radius, a procedure which offers tremendous benefits in terms of pain, strength, and functionality. Here we describe a unique technique to address the malunion of an extra-articular distal radius fracture using a radial anatomic plate. This is a simple and reproducible method of fixation involving straightforward anatomy, which does not require excessive radiography, and which represents an excellent choice of fixation in the distal radius malunion.
Collapse
|
|
23
|
Mathew P, Garcia-Elias M. Anterolateral surgical approach to the malunited distal radius fracture for corrective osteotomy and bone-graft harvest. Tech Hand Up Extrem Surg 2013; 17:28-34. [PMID: 23423232 DOI: 10.1097/bth.0b013e3182736d27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The most common complication after distal radius fractures is union with deformity. When symptomatic, distal radial malunions may require operative intervention. Numerous approaches to the distal radius have been described. Most volar approaches involve sectioning the brachioradialis and opening the first extensor compartment to permit adequate exposure. When bone graft is required, this may necessitate a separate incision and further add to the morbidity. We present an alternative anterolateral surgical approach to the distal radius, which allows for excellent exposure, and minimal trauma to the tendons while permitting harvest of local bone graft through the same incision.
Collapse
Affiliation(s)
- Philip Mathew
- Pulvertaft Hand Centre, Royal Derby Hospital, Kings Treatment Centre, Derby, UK.
| | | |
Collapse
|
|
24
|
Mahmoud M, El Shafie S, Kamal M. Correction of dorsally-malunited extra-articular distal radial fractures using volar locked plates without bone grafting. ACTA ACUST UNITED AC 2012; 94:1090-6. [PMID: 22844051 DOI: 10.1302/0301-620x.94b8.28646] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Malunion is the most common complication of the distal radius with many modalities of treatment available for such a problem. The use of bone grafting after an osteotomy is still recommended by most authors. We hypothesised that bone grafting is not required; fixing the corrected construct with a volar locked plate helps maintain the alignment, while metaphyseal defect fills by itself. Prospectively, we performed the procedure on 30 malunited dorsally-angulated radii using fixed angle volar locked plates without bone grafting. At the final follow-up, 22 wrists were available. Radiological evidence of union, correction of the deformity, clinical and functional improvement was achieved in all cases. Without the use of bone grafting, corrective open wedge osteotomy fixed by a volar locked plate provides a high rate of union and satisfactory functional outcomes.
Collapse
Affiliation(s)
- M Mahmoud
- Kasr Al Ainy Faculty of Medicine, Cairo University, Al-Manial, 11956, Cairo, Egypt.
| | | | | |
Collapse
|
|
25
|
Coulet B, Id El Ouali M, Boretto J, Lazerges C, Chammas M. Is distal ulna resection influential on outcomes of distal radius malunion corrective osteotomies? Orthop Traumatol Surg Res 2011; 97:479-88. [PMID: 21802384 DOI: 10.1016/j.otsr.2011.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 01/15/2011] [Accepted: 03/07/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The mechanical repercussions of distal radius malunion on the distal radio-ulnar (DRU) joint are common and inconsistently corrected by radius osteotomy alone. Ulnar resection has thus become a palliative solution. HYPOTHESES Does ulna resection influence the outcomes of distal radius malunion corrective osteotomies? What preoperative factors warrant preserving the distal radio-ulnar joint? PATIENTS AND METHODS Twenty-one corrective osteotomies of the radius were retrospectively reviewed. Ulna resection was performed in cases of cartilage damage, joint incongruence, or persistent stiffness in pronosupination after osteotomy of the radius. After the osteotomies, two groups were identified: 10 cases with preservation of the distal end of the ulna (DRU+) and eleven with distal resections (DRU-). RESULTS At review, all the osteotomies had united, with comparable anatomical restoration of the radial epiphysis for the two groups. We noted a statistically significant gain in mobility after osteotomy for both techniques (but no difference between them) and comparable grip strengths with 89.8% of the contralateral side for the DRU+ group versus 90.4% for the DRU- group. Pain (scale, 0-3) had significantly diminished for both groups decreasing from 1.9 to 0.3 for the DRU+ group and from 2.5 to 1.1 for the DRU- group, with no significant difference between them. The Mayo Clinic Wrist Score and the DASH score did not differ significantly with 73/100 and 13.5 for the DRU+ group compared with 68.2/100 and 20.2 for the DRU- group, respectively. DISCUSSION These results show that the impact of ulna resection after distal osteotomy of the radius is limited as reflected by radiological correction, mobility and grip strength. However, after resection pain in the ulnar tilt of the wrist due to instability of the distal ulnar stump was noted. Besides cartilage damage, ulnar deviation of over 5mm was, for this series, a constant factor in non-preservation of the DRU joint. LEVEL OF EVIDENCE Level IV. Retrospective study.
Collapse
Affiliation(s)
- B Coulet
- Lapeyronie Regional Academic Hospital Center, Upper Extremity and Hand Surgery Department, 371, avenue du Doyen-Gaston-Girard, Montpellier cedex 5, France.
| | | | | | | | | |
Collapse
|