Open Wedge Osteotomy for Malunited Extraarticular Distal Radius Fractures with Plate Osteosynthesis without Bone Grafting

Abstract

Malunion of distal radius fractures can cause pain, limited wrist motion, or loss of grip strength. The most important factors are incongruity in the distal radioulnar (DRU) joint and radial tilt which causes adaptive carpal instability. The purpose of open wedge corrective osteotomy is to restore congruency with minimal soft-tissue damage. Between 1993 and 2001, 47 patients with malunited extraarticular distal radius fractures who were treated by open wedge corrective osteotomy without bone grafting were included. The patients were divided into two groups, one group with dorsal tilt of the distal radius and one group with palmar tilt. Ulnar variance, radial inclination, and radial tilt were measured before and after operation. Also, the range of wrist motions was tested before and after correction, including grip strength. Fixation was performed with a dorsal or palmar plate, dependent on the side of radial tilt. Improvement of especially radial tilt was seen in both groups. Also, an important increase in wrist motions was observed. Flexion of the wrist improved by 38.0° in the dorsal group and by 43.0° in the palmar group. With respect to rotation of the lower arm, supination improved most by 21.6° and 46.0° in the dorsal and palmar group, respectively. All osteotomies healed within 3 months without secondary displacement even after a short period of immobilization. Corrective osteotomy is a useful additional therapy in the treatment of malunited extraarticular fractures of the distal radius in which bone grafting is not necessary.