Immediate Mobilisation Following Corrective Osteotomy of Distal Radius Malunions with Cancellous Graft and Volar Fixed Angle Plates

2007 ◽  
Vol 32 (1) ◽  
pp. 88-92 ◽  
Author(s):  
M. HENRY
Keyword(s):  
Distal Radius ◽  
Cancellous Bone ◽  
Iliac Crest ◽  
Corrective Osteotomy ◽  
Forearm Rotation ◽  
Heavy Smoking ◽  
Cancellous Bone Grafting ◽  
Wrist Motion ◽  
Fixed Angle ◽  
Volar Approach

The purpose of the study was to examine the reliability with which a specific technique of corrective osteotomy of malunions of the distal radius combined with early mobilisation could both restore the normal anatomic parameters of the radius and achieve a functional range of motion with good strength. Corrective osteotomy of the distal radius was performed through a volar approach using a fixed angle volar plate and cancellous bone graft from the iliac crest in 19 patients of mean age 50 years with initial malunions with a mean dorsal tilt of 36° and 7 mm of ulnar variance. An immediate mobilisation programme was started. All healed at a mean of less than 12 weeks (including two heavy smoking patients who required repeat cancellous bone grafting to achieve final union) to achieve a total arc of wrist motion around 120°, forearm rotation of 158° and grip strength which was 80% of contralateral. This treatment strategy was judged to be straightforward and effective.

MALUNITED FRACTURES OF THE DISTAL RADIUS TREATED WITH CORRECTIVE OSTEOTOMY USING VOLAR LOCKING PLATE AND A CORTICOCANCELLOUS BONE GRAFT FOLLOWING IMMEDIATE MOBILISATION

Hand Surgery ◽  
2007 ◽  
Vol 12 (03) ◽  
pp. 183-190 ◽  
Author(s):  
Denju Osada ◽  
Shuzo Kamei ◽  
Morimitsu Takai ◽  
Kazuo Tomizawa ◽  
Kazuya Tamai
Keyword(s):  
Distal Radius ◽  
Bone Grafting ◽  
Locking Plate ◽  
Corrective Osteotomy ◽  
Treatment Method ◽  
Contralateral Side ◽  
Volar Locking Plate ◽  
Forearm Rotation ◽  
Volar Approach

We describe our experience of using a volar locking plate for corrective osteotomy and bone grafting combined with early mobilisation in the treatment of distal radius malunions. Corrective osteotomy of the distal radius was performed through a volar approach, and fixated by a volar locking plate associated with corticocancellous iliac bone grafting in three patients aged 16, 71 and 75 years. Two patients had had volarly displaced malunion and one dorsally displaced malunion. Wrist motin was started immediately after surgery. The average follow-up was 15 months (range, 12–20 months). All osteotomies healed at an average 5.7 weeks post-operatively, resulting in a total arc of wrist motion of 133°, forearm rotation of 167°, and grip strength of 70% of that of the contralateral side. This treatment method proved to be effective and safe.

TREATMENT OF SCAPHOID NONUNION USING VOLAR BICONCAVE CANCELLOUS BONE GRAFTING

Hand Surgery ◽  
2007 ◽  
Vol 12 (02) ◽  
pp. 135-140 ◽  
Author(s):  
M. Yasuda ◽  
Y. Ando ◽  
K. Masada
Keyword(s):  
Cancellous Bone ◽  
Bone Grafting ◽  
Bony Union ◽  
Scaphoid Nonunion ◽  
Radiographic Appearance ◽  
Cancellous Bone Grafting ◽  
Volar Approach ◽  
Pin Fixation ◽  
The Mean ◽  
Grafting From

We report the results of 28 patients with scaphoid nonunion treated with curettage and biconcave cancellous bone grafting from the distal radius using a volar approach and pin fixation. This study consisted of 28 patients (24 males and 4 females). The mean age at surgery was 28 years. The mean interval from injury to surgery was 22 months. The mean follow-up period was 20 months. By Russe classification, there were 6 distal third nonunions, 19 middle third nonunions and 3 proximal third nonunions. We reviewed final function and radiographic appearance. Bony union was achieved in all cases. Pins were removed at a mean of 7 weeks after surgery. Post-activity pain resolved in all cases. Mean wrist extension was 79° and mean flexion 77°. Mean grip strength was 35.8 kgf. The mean postoperative radio-lunate angle was 4.9° (-21–28.8) compared to -5.9° (-37.5–17.5) preoperatively. No complications were encountered. Our procedure is straightforward and not technically demanding. An STT arthrotomy is not necessary and the technique allows for concurrent correction of carpal instability. Bony union was achieved in all cases with no complications.

scholarly journals Early Correction of Distal Radius Partial Articular Malunion Leads to Good Long-term Functional Recovery at Mean Follow-up of 4 Years

Hand ◽  
2018 ◽  
Vol 15 (2) ◽  
pp. 276-280 ◽  
Author(s):  
T. David Luo ◽  
Fiesky A. Nunez ◽  
Elizabeth A. Newman ◽  
Fiesky A. Nunez
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Articular Surface ◽  
Corrective Osteotomy ◽  
Young Patients ◽  
Posttraumatic Arthritis ◽  
Volar Approach ◽  
Pain Scores

Background: Distal radius articular step-off or deformity may cause posttraumatic arthritis and poor functional outcome. The purpose of this study was to evaluate pain and functional outcomes in patients with malunited partial articular distal radius fractures who underwent corrective osteotomy. We hypothesized that anatomic restoration of distal radius articular surface after a malunited partial articular distal radius fracture results in improvement in pain and functional measures and delays the development of posttraumatic arthritis. Methods: Seven consecutive patients with mean age of 38 years underwent corrective osteotomy via either a standard dorsal approach or combined dorsal and volar approach. Mean time from injury to corrective osteotomy was 10 weeks. Patients were assessed with respect to Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), forearm and wrist range of motion, pain, and grip strength. Results: At mean follow-up of 44 months, significant improvements in pain scores (7.1-0.9, P < .001), QuickDASH (38.7-11.6, P < .001), grip strength (21.4-30.0 kg, P = .01) were achieved. All range of motion measurements demonstrated significant improvements except forearm pronation. One patient demonstrated radiographic evidence of osteoarthritis but had no pain at final follow-up. No patients required secondary surgery for removal of symptomatic hardware. Conclusions: Based on these findings, we recommend that early corrective osteotomies should be considered in young patients with intra-articular distal radius malunions before considering salvage procedures such as partial or complete wrist arthrodesis.

Should We Repair the Pronator Quadratus in a Distal Radius Fracture with an Ulnar Styloid Base Fracture? A Biomechanical Study

2021 ◽  
Author(s):  
Mauro Maniglio ◽  
Victor Truong ◽  
Matthias Zumstein ◽  
Lilianna Bolliger ◽  
Michelle H. McGarry ◽  
...  
Keyword(s):  
Distal Radius ◽  
Distal Radioulnar Joint ◽  
Biomechanical Study ◽  
Forearm Rotation ◽  
Ulnar Styloid ◽  
Pronator Quadratus ◽  
Volar Approach ◽  
Druj Instability ◽  
Cadaveric Model

Abstract Background Merits of repairing the pronator quadratus (PQ) to restore distal radioulnar joint (DRUJ) stability after a volar approach remain controversial. Distal radius fractures are often associated with ulnar styloid fractures (USF). When involving the fovea, this USF can lead to a DRUJ instability. The PQ repair may be key in reducing this DRUJ instability. Methods This study aims to assess the biomechanical role of PQ repair in a cadaveric model of USF. In 17 forearm specimens, a USF including the fovea was executed. Positional changes of the DRUJ in forearm rotation and dorso-palmar (DP) translation were measured with variable loads (0, 2.5, and 5N) applied to the PQ origin. Results Forearm rotation and DP-translation decreased significantly with PQ loading of 5N, changing on average by 5 degrees and 0.6 mm, respectively. Conclusion We found a significant decrease in forearm rotation and DP-translation comparing a fully loaded PQ to an unloaded PQ in our cadaveric model.

Corrective distal radius osteotomy following fracture malunion using a fixed-angle volar locking plate

2013 ◽  
Vol 39 (4) ◽  
pp. 431-435 ◽  
Author(s):  
S. Opel ◽  
S. Konan ◽  
E. Sorene
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Wrist Joint ◽  
Corrective Osteotomy ◽  
Volar Locking Plate ◽  
Short Term ◽  
Fixed Angle ◽  
Post Traumatic ◽  
Radiological Union

Post-traumatic distal radius deformity may cause severe morbidity, and corrective osteotomy is often necessary to realign the functional axis of the wrist to correct symptomatic malunion. The aim of this retrospective study was to review the short-term results of a single surgeon’s series of distal radius corrective osteotomies following fracture malunion using a fixed-angle volar locking plate for 20 patients (26 women) of an average age of 57 (range 19–83) years. At short-term follow up (average 14 months, range 12–15 months), no complications were noted and radiological union was confirmed in all cases at an average of 3 months. The average post-operative Disability of the Arm, Shoulder and Hand score was 13.48 (range 0–48.33) and an objective improvement was noted in movements at the wrist joint. A statistically significant improvement was achieved in ulnar variance, radial inclination, dorsal tilt, and supination.

A Case of Non-Union of Ulna Fracture Managed with Tibial Strut Cortico-Cancellous Bone Grafting in a Paediatric Patient

2017 ◽  
Vol 22 (03) ◽  
pp. 396-402
Author(s):  
Collin S.K. Looi ◽  
Roohi S.A. ◽  
Ranjit Singh Gill
Keyword(s):  
Paediatric Patient ◽  
Cancellous Bone ◽  
Bone Grafting ◽  
Iliac Crest ◽  
Bone Transport ◽  
Forearm Fractures ◽  
Cancellous Bone Grafting ◽  
Non Union ◽  
Fractures In Children ◽  
Fibular Grafting

Forearm fractures in children complicated with non-union are uncommon. Various methods have previously been reported to manage this condition. Well documented techniques would include iliac crest grafting, cancellous insert grafting, ulnar segment grafting, cortical tibial grafting, vascularized fibular grafting and bone transport by ring fixation. The authors present a case of a child with an atrophic non-union of the ulna who was successfully treated with a cortico-cancellous tibial strut bone graft.

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