Corrective osteotomy for malunion of the distal radius in young and middle-aged patients: an outcome study.

INTRODUCTION: We report the outcome of osteotomy for malunion of the distal radius.

MATERIAL AND METHODS: Twenty-one wrists in 21 patients (mean age 38 years) with a malunion of the distal radius were treated with an osteotomy. An opening wedge osteotomy was performed when the distal radioulnar joint (DRUJ) could be saved; a closing wedge osteotomy was done when the DRUJ was treated with resection (Darrach) or arthrodesis (Sauvé-Kapandji). The clinical and radiographic outcomes were evaluated together with the DASH score (disability of shoulder and hand).

RESULTS: Extension improved to an average of 48 degrees in the Smith-type group and flexion improved to an average of 51.8 degrees in the Colles-type group. The postoperative DASH-score averaged, respectively, 17.3 and 33. There were four poor, four fair, seven good and six excellent scores on the scale of Fernandez and there were four poor, seven fair, three good and seven very good results on the Fernandez point score. Grip strength postoperatively averaged 70% of the contralateral side. Radiographically, there was a correction of increased volar tilt of the articular surface from 30.6 to 4.0 degrees in the Smith-type group and a correction of increased dorsal tilt of the articular surface of 24.6 degrees (from -21.3 to 3.3 degrees) in the Colles-type group. Nine patients had surgery on the distal ulna at the time of the radial correction. Their average DASH score was 16.8 compared to the 33.97 average DASH score of those with radial correction without ulnar surgery.

CONCLUSION: Osteotomy of the distal radius in cases of malunion gives favorable outcomes. Treatment of the DRUJ is mandatory.