Corrective Osteotomy of Malunited Fractures of the Distal Radius Using a Combined Surgical Approach.

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.