Article

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

Journal of wrist surgery 02/2013; 2(1):49-54. DOI: 10.1055/s-0032-1326725
Source: PubMed

ABSTRACT

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.

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Available from: Andreas Schweizer, Sep 17, 2015
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    • "The healing time was comparable using the graft or not (mean 12.5 wk), ranging from 7.5[24]to 16[25,26]wk. The mean DASH score improvement was 23 points both in the studies describing the use of the graft (range, 11-46)222324272829, and in those not using the graft (range, 13-28)[25,303132. Finally, few studies reported postoperative complications[11,22,23,26,29,32]. "

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    • "Although the functional consequences are usually well tolerated, surgical correction may be indicated if ulno-carpal conflict or symptomatic loss of wrist motion occurs [2]. Different surgical procedures have been described for osteotomy fixation: pins, external fixators and recently locking plates [3] [4] [5]. For some authors, the bone loss caused by the osteotomy must be filled by bone [6], cartilage [7] or bone substitute [8]. "
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    ABSTRACT: La fréquence des cals vicieux après fractures du radius distal est de 25 % après traitement conservateur et 10 % après chirurgie. Leur principale manifestation fonctionnelle, réduction de la mobilité du poignet, est liée au conflit ulno-carpien.
    Full-text · Article · Nov 2015 · Revue de Chirurgie Orthopédique et Traumatologique
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    • "Although the functional consequences are usually well tolerated, surgical correction may be indicated if ulno-carpal conflict or symptomatic loss of wrist motion occurs [2]. Different surgical procedures have been described for osteotomy fixation: pins, external fixators and recently locking plates [3] [4] [5]. For some authors, the bone loss caused by the osteotomy must be filled by bone [6], cartilage [7] or bone substitute [8]. "
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    ABSTRACT: The rate of malunion after distal radius fractures is 25% after conservative treatment and 10% after surgery. Their main functional repercussion related to ulno-carpal conflict is loss of wrist motion. We report a retrospective clinical series of minimally invasive osteotomies. The series consisted of 9 cases of minimally invasive osteotomies with volar locking plate fixation. All osteotomies healed. The average pain was 5.3/10 preoperatively and 2.1/10 at last follow-up. The mean Quick DASH was 55.4/100 preoperatively and 24.24/100 at last follow-up. Compared to the opposite side, the average wrist flexion was 84.11%, the average wrist extension was 80.24%, the average pronation was 95.33% and the average supination was 93.9%. With similar results to those of the literature, our short series confirms the feasibility of minimally invasive osteotomy of the distal radius for extra-articular malunion. Type: Case-series. Level of evidence: IV.
    Full-text · Article · Oct 2015 · Orthopaedics & Traumatology Surgery & Research
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