70 Corrective osteotomy of malunited radial fractures: does the anatomical result affect the clinical outcome ?

Abstract

From the acute distal radial fracture it is well known, that the anatomical result affects the final function. Corrective osteotomy of malunited distal radial fractures has been shown to improve wrist motion and forearm rotation and decrease pain. The aim of this study was to evaluate, if the anatomical result following corrective osteotomy of a malunited distal radial fracture influences the functional outcome. Twenty corrective osteotomies of malunited Smith's type fractures were investigated. According to the postoperative radiological result the patients were divided into two groups. Group I included ail patients with at least anatomically corrected minimally two of three radiological parameters (radius tilt, ulnar inclination and ulnar variance). Group II included ail patients with less than two of the three parameters corrected into normal limits. Using the nonparametric Mann-Whitney-U-test the clinical results (wrist motion, forearm rotation, grip strength, pain relief, DASH-score) were evaluated for a statistic significant difference between the two groups (P < 0.05 = significant, P < 0.01 high significant). Group I included 9 patients, group II 11 patients. Patients of group I achieved superior clinical results than patients of group II. The final function of group I was statistically significant better for : wrist flexion (P = 0.02), total range of ulnar-/radial deviation (P = 0.02), forearm pronation (P = 0.03), grip strength (P = 0.04) and pain relief (P = 0.05). The final clinical outcome of group I was statistically highly significant better for : wrist extension (P = 0.001), range of wrist extension/flexion (P = 0.001), forearm supination (P = 0.01) and total range of forearm supination/pronation (P = 0.01). The DASH-score demonstrated a difference between the two groups, but significance was slightly missed (P = 0.079). The amount of anatomical reconstruction of the wrist joint achieved by corrective osteotomy in malunited Smith fractures affects the clinical outcome.