Opening-wedge osteotomy, bone graft, and external fixation for correction of radius malunion

Surgery may be indicated in treating Madelung’s deformity and numerous techniques have been described. This study reports the early clinical and radiological results of a radial biplanar opening wedge osteotomy and modified Darrach procedure, using the excised ulnar head as a trapezoidal bone graft. Between 2000 and 2008, five adult wrists with symptomatic Madelung’s deformity underwent surgery. All patients were female, with an average age at surgery of 34 years. Assessment included range of movement, grip strength, DASH scores and radiological imaging. All patients improved both subjectively and objectively with regards to pain, functional range of movement, and appearance at mean follow-up of 55 months (range 14—113). All osteotomies united. One patient required removal of hardware for restricted rotation. This technique provided satisfactory results that are comparable to other studies, and avoids the use of iliac crest bone graft.

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TRAPEZOID ROTATIONAL BONE GRAFT OSTEOTOMY FOR METACARPAL AND PHALANGEAL FRACTURE MALUNION

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2007.01.005 ◽

2007 ◽

Vol 32 (3) ◽

pp. 282-288 ◽

Cited By ~ 7

Author(s):

F. C. YONG ◽

S. H. TAN ◽

B. P. B. TOW ◽

L. C. TEOH

Keyword(s):

Bone Graft ◽

Corrective Osteotomy ◽

Wedge Osteotomy ◽

Angular Deformity ◽

Opening Wedge ◽

Metacarpal Head ◽

Bone Length ◽

Double Osteotomy ◽

Bone Shortening ◽

Phalangeal Fracture

Metacarpal and phalangeal fracture malunions with significant angulation deformity are associated with bone shortening, prominence of the metacarpal head in the palm or pseudoclaw deformity and may be symptomatic. If so, they may need corrective osteotomy procedures. Conventional methods of closing, or opening, wedge osteotomy do not restore the length of the bone exactly. Simultaneous correction of the angular deformity and restoration of bone length can be addressed by a trapezoid rotational bone graft osteotomy. A double osteotomy is done and the segment of bone is rotated and re-inserted as a bone graft. This was done successfully in four metacarpal and two phalangeal fracture malunions with angulation deformities.

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

Journal of Wrist Surgery ◽

10.1055/s-0032-1326725 ◽

2013 ◽

Vol 02 (01) ◽

pp. 049-054 ◽

Cited By ~ 14

Author(s):

Esin Rothenfluh ◽

Andreas Schweizer ◽

Ladislav Nagy

Keyword(s):

Distal Radius ◽

Wedge Osteotomy ◽

Opening Wedge ◽

Palmar Approach ◽

Distal Radius Malunion ◽

Radius Malunion

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CORRECTIVE OSTEOTOMY AND LOCAL BONE GRAFTING FOR EXTRA-ARTICULAR MALUNION OF THE PROXIMAL PHALANX

Hand Surgery ◽

10.1142/s0218810412720410 ◽

2012 ◽

Vol 17 (03) ◽

pp. 399-403

Author(s):

John T. Capo ◽

Ben Shamian ◽

Philip K. Lim

Keyword(s):

Bone Graft ◽

Hand Function ◽

Corrective Osteotomy ◽

Proximal Phalanx ◽

Wedge Osteotomy ◽

Angular Deformity ◽

Opening Wedge ◽

Local Bone ◽

Dual Plating ◽

Osteotomy Technique

Corrective osteotomies are often utilised to treat finger deformities that may occur due to a phalangeal malunion. Rotational or angular malalignment, in addition to shortening of the digit may negatively affect hand function and be aesthetically displeasing. Thorough preoperative examination of the malunion and its associated deformities is crucial in determining the type of osteotomy technique to be used. Osteotomies can create bony defects that need to be filled with bone graft or some type of graft substitute. We describe an opening wedge osteotomy with local cancellous bone graft combined with dual plating to treat a dorsal angular deformity in a proximal phalangeal malunion.

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Opening Wedge Osteotomy and Bone Grafting for Distal Radius Malunion

Hand Surgery ◽

10.1142/s0218810497000343 ◽

1997 ◽

Vol 02 (02) ◽

pp. 191-202 ◽

Cited By ~ 3

Author(s):

Takuro Wada ◽

Masamichi Usui ◽

Mitsuhiro Aoki ◽

Seiichi Ishii

Keyword(s):

Distal Radius ◽

Bone Grafting ◽

Functional Disability ◽

Functional Score ◽

Wedge Osteotomy ◽

Opening Wedge ◽

Limited Range Of Motion ◽

Distal Radius Malunion ◽

Radial Length ◽

Radius Malunion

We performed opening wedge osteotomy and bone grafting in conjunction with buttress plate fixation for distal radius malunion of 16 wrists in 15 patients (nine dorsal and seven volar displacements). Surgery was indicated in manually active patients with functional disability in the wrist due to a limited range of motion, weakness in grip, and pain. Surgery was attempted to restore the anatomical configuration of the distal radius: volar tilt, radial inclination, and radial length. The preoperative average volar tilt was -31° for dorsal displaced malunions and 28° for volar displaced malunions. The postoperative volar tilt was restored to 3° for dorsal diplaced malunions and to 10° for volar displaced malunions. Radial shortening was corrected from 6.8 mm to 1.4 mm. The preoperative combined dorsal and volar flexion of all patients improved from an average of 87° to 136°. Combined pronation and supination of the forearm improved from an average of 115° to 159°. Subjective evaluation by Saito's functional score was excellent in nine wrists, good in four, fair in two, and poor in one. The poor and fair results were due to residual deformities in volar tilt and radial length.

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