A study on functional and radiological outcome after corrective osteotomy and volar locked plate fixation for extra-articular malunion of distal radius

Abstract

Background: Malunion is the most common complication following distal radius fractures occurring approximately 23% of non-surgically treated injuries and approximately 11% of operatively treated fractures. Malunion leads to functional limitation of affected wrist significantly requiring intervention. We report the functional and radiological outcome after corrective osteotomy of malunited distal radius using volar approach and fixation with a volar locked plate. Material and methods: Fifteen malunited distal radius in skeletally matured patients were treated with an osteotomy and iliac crest corticocancellous bone graft. Osteotomy was fixed in corrected position using a distal radius volar locking plate. Outcomes were evaluated using Modified Grahams criteria for acceptable healing, Fernandez scale, Modified Mayo wrist score and DASH questioner. Results: On radiological evaluation radial tilt was in the range of 9 degree dorsal to 20 degree volar. All osteotomies healed within acceptable limit by modified Graham’s radiographic criteria of acceptable healing of distal radius fractures. Functional evaluation by Fernandez scale shows excellent result in 3, good in 7, 5 fair and no poor result. Modified Mayo wrist score assessment shows 4 excellent, 6 good, 5 satisfactory and no poor result. The average score is 78.67 (range 65-90). DASH questioner analysis postoperatively revealed the average score is 15.93 improved from preoperative mean 50.8. One patient required concomitant ulnar shortening osteotomy. Conclusion: Corrective osteotomy and volar locked plate fixation of distal radius for symptomatic malunion gives favourable radiological and functional outcome and should be carried out in patients with high functional demand of the wrist joint.