Malunited Colles Research Articles

Radius-ulna shaft fracture with distal radioulnar joint instability in a case of ipsilateral malunited colles fracture: a case report

<p class="abstract">Malunion of the distal end of radius is a known consequence of the conservative management. The functional impairment depends on the severity of the deformity and it can be associated with distal radioulnar joint (DRUJ) instability. Subsequent radius ulna fracture in an elderly osteoporotic patient is a challenging task to manage. A 60 year old female patient came with radius ulna shaft fracture with DRUJ instability with ipsilateral malunited distal radius fracture. We managed with open reduction and internal fixation using 3.5 mm locking compression plate (LCP) with ulnar shortening and K wires for DRUJ. At one year, follow-up, patient is having good clinical and radiological outcome without any complications. Radius ulna shaft fracture in cases of malunited colles fracture with positive ulnar variance with DRUJ instability can be managed well with open reduction and internal fixation of radius-ulna shaft which provides stable fixation, ulnar shortening at the fracture site to maintain the neutral/negative ulnar variance and DRUJ fixation using K wires. Use of multiple vicryl sutures to tie the plate to the bone gives additional stability in osteoporotic bones till the fracture unites and prevents implant failure. Combination of the above mentioned procedures helps in getting good functional outcome in elderly osteoporotic patients.</p>

Ulnar shortening osteotomy as a treatment of symptomatic ulnar impaction syndrome after malunited distal radius fractures.

A malunited distal radius fracture can lead to symptomatic ulnar impaction syndrome, which is a common cause for ulnar-sided wrist pain. If conservative treatment fails and symptoms persist after an arthroscopic ulnocarpal debridement, ulnar shortening osteotomy (USO) is the treatment of choice. Since the first USO described by Milch in 1941 after a malunited Colles fracture, many techniques have been described varying in surgical approach, type of osteotomy and osteosynthesis material used. Many studies demonstrated good to very good functional results after USO, reporting, however, a delayed union or non-union rate up to 18%. A modern, low profile, locking plate showed in our short-term study very good functional results and no implant-associated complications, in particular no non-union.

Opening Wedge Osteotomy for Distal Radius Malunion: Dorsal or Palmar Approach?

Background There are various technical variations to consider when performing a corrective osteotomy of a distal radius malunion. We chose two of the more commonly reported techniques and compared the results of volar (palmar) osteotomy and fixation with dorsal osteotomy and fixation. Method Within a continuous cohort of patients who had undergone corrective osteotomy for a malunited Colles fracture, two groups could be identified retrospectively. In 8 patients a dorsal approach was used. A structural trapezoidal graft, subtending the amount of correction, was inserted into the osteotomy gap and stabilization was performed with a thin round-hole mini-fragment plate. In 14 patients a palmar approach and a palmar fixed-angle plate was used for correction of the malunion and for angular stable rigid fixation of the two fragments. The osteotomy gap was loosely filled with nonstructural cancellous bone chips. A retrospective comparison of the two groups was performed to see whether the outcome was affected by the use of either operative technique.The demographics, the preoperative amount of deformity, range of motion, pain, and force were comparable for both groups. All osteotomies healed without loss of correction. After a minimal follow-up of one year, radiographic appearance, objective functional parameters were assessed and subjective data (Disabilities of the Arm, Shoulder, and Hand [DASH] score and special pain and function questionnaire) obtained. Results These data did not show statistical difference for the two groups except for the amount of final wrist flexion. This parameter was significantly better in patients who had palmar approaches and fixed-angle plates. Conclusion Corrective osteotomies of distal radius malunions can be done in either way. It might result in some better flexion, if performed volarly.

Flexor tendon rupture of small finger due to osteoarthritis of distal radioulnar joint after malunited Colles' fracture: a case report

Flexor tendon rupture of small finger due to osteoarthritis of distal radioulnar joint after malunited Colles' fracture: a case report

Early corrective osteotomy for a malunited Colles’ fracture using volar approach and calcium phosphate bone cement: A case report

We report a case of malunion of the distal radius after a Colles' fracture treated with osteotomy using a volar approach combined with calcium phosphate bone cement grafting of the dorsal defect via a drill hole from the volar cortex 6 weeks after the injury. One year and 4 months after surgery range of motion and grip strength were improved and x-rays of the wrist showed complete union of the distal radius with progressive absorption of the calcium phosphate bone cement.

Complications Following Distal Radial Fractures

Union with deformity is the most common complication following a distal radial fracture1-5. The deformity may be extra-articular, characterized by loss of length and metaphyseal angulation; it may be intra-articular, involving either the radiocarpal or the radioulnar joint, or both; or it may be a combination of the two. Surgical treatment of a symptomatic malunion of the distal part of the radius has been recognized for more than 200 years. Resection of the distal aspect of the ulna for the management of pain at the distal radioulnar joint after a distal radial fracture, a procedure attributed to Darrach after his description in 19136, had been suggested by Desault in 17917 and again by Moore in 18808. In 1937, Campbell described a corrective osteotomy of the distal part of the radius with use of an interpositional bone graft obtained from the distal part of the ulna9. In 1945, Merle d’Aubigne and Joussement described a multiple-facet curved osteotomy without the need for an interpositional bone graft10. This concept is currently being revisited and will be described. A deformity following fracture of the distal part of the radius is not necessarily symptomatic. In fact, it is not uncommon for an older patient to have acceptable wrist and forearm function without pain even when there is an apparent deformity. Therefore, impairment of function rather than radiographic deformity is the reason to treat a distal radial malunion, and, consequently, the patient’s wrist and forearm function must be assessed. The most common deformity following a malunited extra-articular Colles type of fracture is the loss of the normal volar tilt of the articular surface in the sagittal plane, loss of ulnar inclination in the frontal plane, loss of length relative to the ulna, and …

Results of corrective osteotomy of malunited extension fractures of the radius at the usual site

There is an increasing interest in the corrective osteotomy for the malunited distal radius fracture. Already in the seventies we developed an operative technique for the correction of the malunited Colles' fracture. The technique is based on a special plate, which facilitates precise restoration of the angulation of the joint surface and the length of the radius. The purpose of our study is to investigate the results of our method and to compare them with results in the literature. We examined retrospectively the patients with a malunited Colles' fracture corrected by our technique until August 1996. The investigated criteria were range of motion, grip strength, pain relief, and X-ray findings. Until August 1996, we have performed 124 corrective osteotomies for malunited Colles' fractures; 115 were carried out by our technique; 91 of them could be examined. The mean follow-up time was 4.5 years. The range of motion has improved in all planes, especially for flexion. Grip strength increased but still remained below the level of the opposite side. On X-ray, average dorsal tilt of the radiocarpal joint was 24 degrees preoperatively and was reduced to an almost normal palmar tilt of 7 degrees. Ulnar-plus variance was reduced from 6 mm to less than 1 mm. Corrective osteotomy of the distal radius is of great benefit and leads to improved hand function and diminished pain. The use of our special plate facilitates this ambitious operation considerably.

The Sauvé-Kapandji procedure in mal-united colles' fractures

The Sauvé-Kapandji procedure in mal-united colles' fractures

Malunited Colles' fracture Analysis of stress distribution

To try to explain disability in the wrist after malunited Colles' fractures, an experiment was designed to evaluate pressure distribution through the wrist joint with varying degrees of angulation of the distal radius. The results of computer simulation analysis of stress concentration using finite element methods were compared with those of pressure distribution studies on the radial articular surface of cadaveric radii in various positions using pressure-sensitive film. Stress existed in volar regions of the radio-lunate joint under normal pressure in the neutral position, but shifted to dorsal regions of the joint, and was concentrated when dorsal angulation reached 30°. We believe that concentrated loads result in pain and may lead to early degenerative joint disease. Early additional reduction of a displaced fragment or a post-fusion osteotomy should be considered when dorsal angulation exceeds 30° in malunited distal radial fractures to decrease abnormal loading across the wrist joint.

陳旧性および反復性尺骨遠位端掌側脱臼３例の経験

Three volar dislocations of the distal ulna with unusual etiology were reported. The first case was a neglected volar dislocation of the ulna with a malunited fragment avulsed from the volar lip of the distal radio-ulnar joint. Satisfactory stability was achieved by open ulnar reduction with reposition and fixation of the malunited fragment. The second case suffered from volar dislocation of the distal ulna on supination. She had had a malunited Colles fracture with 5mm ulna plus variant and 30 degree dorsal tilt of the distal radius. Closing wedge osteotomy of the radius and shortening osteotomy of the ulna were done in order to realign the distal radio-ulnar joint. She regained painless pronation (60 degrees) and supination (90 degrees). The third case was a 13 year old boy who had a recurrent volar dislocation of the distal ulna which was possibly caused by shortening and angulation of the ulna secondary to growth disturbance of distal ulnar epiphysis due to trauma at 6 years of age. Physiological alignment of the distal radioulnar joint was achieved by opening wedge osteotomy of the ulna.

Treatment of unstable Colles' fractures with a new radius mini-fixator

An external fixator has been developed that is confined to the radius. It is lightweight, has a low profile, and its application is uncomplicated. Because the fixator provides rigid fixation of the fracture fragments, it has the important advantage of allowing immediate active wrist exercises, thus facilitating early restoration of mobility. The radius mini-fixator has been effective in the treatment of unstable Frykman Type I and II Colles' fractures that account for 36.3% in Frykman's series. It has also been used to stabilize osteotomies of the radius for malunited Colles' fractures.

Multiple flexor tendon ruptures following colles' fracture: A case report

Flexor tendon ruptures are a very rare complication of Colles' fracture. Only ten cases have been previously reported in the literature. We describe a case of multiple sequential flexor tendon rupture as a delayed consequence of a malunited Colles' fracture.