Distal radial osteotomy for malunion using non-bridging external fixation: good results in 23 patients

Margaret M McQueen, Alison Wakefield
Acta Orthopaedica 2008, 79 (3): 390-5

BACKGROUND AND PURPOSE: Symptomatic malunion of the distal radius is a common problem and is treated by distal radial osteotomy. Plating is commonly used but has a high rate of plate removal. This study is a report of the functional and radiographic outcome of a prospective series of distal radial osteotomies using non-bridging external fixation.

METHODS: 23 patients with a median age of 60 (18-84) years underwent distal radial osteotomy using non-bridging external fixation and bone grafting for dorsal malunion of a fracture of the distal radius. There were no cases of intraarticular malunion. Radiographic, functional, and patient-assessed outcomes were assessed preoperatively and until 6 months after surgery.

RESULTS: The mean preoperative dorsal angle of 20 (5-40) degrees was corrected to over 5 (0-15) degrees of volar tilt (p < 0.001) and the mean preoperative positive ulnar variance of 3.9 (0-8) mm was corrected to 2.5 (0-8) mm (p = 0.005). Carpal alignment was restored in 22 of the 23 patients. 5 patients required simultaneous ulnar surgery, 1 required ulnar shortening, and 4 required modified Bower's procedures. By 6 months postoperatively, all measures of function except extension and key grip strength showed statistically significant improvements in their means. The SF36 showed statistical improvements in two domains, role physical and bodily pain. There were 2 patients with extensor pollicis longus ruptures and 13 with minor pin-track infections.

INTERPRETATION: Distal radial osteotomy for dorsal malunion of the distal radius using non-bridging external fixation is a successful technique for correction of deformity and restoration of function, with the advantages of being less invasive and not requiring further surgery for removal of metalwork.

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