Simplifying the Volar Distraction Osteotomy for Distal Radius Malunion Repair

2021 ◽  
Author(s):  
Luke P. Robinson ◽  
Rashad H. Usmani ◽  
Victor Fehrenbacher ◽  
Lauren Protzer
Keyword(s):  
Grip Strength ◽  
Distal Radius ◽  
Nonoperative Management ◽  
Corrective Osteotomy ◽  
Ulnar Variance ◽  
Wrist Flexion ◽  
Articular Fractures ◽  
Calcium Phosphate Bone Cement ◽  
Distal Radius Malunion ◽  
Radius Malunion

Abstract Background Extra-articular fractures of the distal radius are often treated with a trial of nonoperative management if radiographic parameters are within an acceptable range, especially in the elderly population. Unfortunately, some malunions become symptomatic or become grossly misaligned during nonoperative management which require corrective surgery to restore the normal osseous anatomy and restore function. Description of Technique We describe correction of a distal radius malunion utilizing a distraction-type volar osteotomy, a volar plate specific distraction device, and a novel resorbable calcium phosphate bone cement (Trabexus) designed to withstand compressive loads. Patients and Methods Twelve patients with 13 distal radius fractures were included in this study. The average patient age was 60.9 years and average time from injury to corrective osteotomy was 96.3 days. Radiographic measures (radial inclination, volar tilt, and ulnar variance) and clinical assessment (wrist/forearm range of motion and grip strength) were done pre- and postoperatively and compared. Results The average time from corrective surgical osteotomy to final clinical follow-up was 375.8 days. After surgical intervention, there was a statistically significant improvement in mean volar tilt (−19.8 vs. +0.5 degrees) and mean ulnar variance (+2.8 vs. −0.4 mm). Improvements were also seen in grip strength (1.7 vs. 43.6 lb), wrist flexion (30.5 vs. 48.3 degrees), wrist extension (33.3 vs. 53.8 degrees), forearm pronation (75.0 vs. 88.8 degrees), and forearm supination (53.8 vs. 81.3 degrees). On average, 56.0% of Trabexus bone substitute remained on final clinical radiographs. Conclusion This simplified technique of distraction corrective osteotomy after distal radius malunion results in improved clinical and radiographic outcomes for patients.

Long-Term Outcomes of Corrective Osteotomy for the Treatment of Distal Radius Malunion

2010 ◽  
Vol 35 (5) ◽  
pp. 370-380 ◽  
Author(s):  
S.A. Lozano-Calderón ◽  
K.M. Brouwer ◽  
J.N. Doornberg ◽  
J. Carel Goslings ◽  
P. Kloen ◽  
...  
Keyword(s):  
Distal Radius ◽  
Corrective Osteotomy ◽  
Long Term Results ◽  
Dash Score ◽  
Wrist Flexion ◽  
Perceived Disability ◽  
Flexion Extension ◽  
Distal Radius Malunion ◽  
Radius Malunion

Corrective osteotomy is an established but challenging treatment for distal radius malunion. Short- and intermediate-term results have been previously published while long-term results have not. The long-term results of 22 patients treated with corrective osteotomy for symptomatic distal radius malunion are presented (range 6—24 years, mean 13 years). All patients completed the DASH questionnaire and the modified Gartland and Werley, and Green and O’Brien scores postoperatively. Wrist alignment was assessed through standard wrist radiographs. Average wrist flexion—extension was 72.5% of the contralateral limb. Grip strength averaged 71%. The DASH score averaged 16 points corresponding to mild perceived disability. Results were categorized as fair on both the Gartland and Werley score (average 9 points) and the modified Green and O’Brien score (average 67 points). Wrist alignment was maintained over time but 13 patients presented mild to moderate symptomatic wrist arthritis. The outcome presented may be a reflection of the use of stricter evaluation instruments or reflect the development of post-traumatic arthritis.

scholarly journals Ulnar Shortening Versus Distal Radius Corrective Osteotomy in the Management of Ulnar Impaction After Distal Radius Malunion

Hand ◽  
2017 ◽  
Vol 13 (2) ◽  
pp. 194-201 ◽  
Author(s):  
William R. Aibinder ◽  
Ali Izadpanah ◽  
Bassem T. Elhassan
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Tourniquet Time ◽  
Ulnar Shortening Osteotomy ◽  
Ulnar Impaction ◽  
Significant Difference ◽  
Distal Radius Malunion ◽  
Ulnar Impaction Syndrome ◽  
Radius Malunion

Background: Distal radius malunions lead to functional deficits. This study compares isolated ulnar shortening osteotomy (USO) to distal radius osteotomy (DRO) for the treatment of ulnar impaction syndrome following distal radius malunion. Methods: We retrospectively reviewed 11 patients with extra-articular distal radius malunions treated for ulnar impaction with isolated USO. This group was compared to a 1:1 age- and sex-matched cohort treated with isolated DRO for the same indication. Pain visual analog scale (VAS), wrist motion, grip strength, radiographic parameters, and perioperative complications were analyzed. Mean follow-up was 14.8 months. Results: VAS scores improved. Wrist range of motion improved in both cohorts with the exception of radial deviation, pronation, and supination in the USO cohort, which decreased from a mean of 17°-16°, 67°-57°, and 54°-52°, respectively. There was no significant difference between groups in regard to change in pain or range of motion, with the exception of pronation and ulnar deviation. The mean tourniquet time was shorter in the USO group. The final ulnar variance was 1.8 mm negative in the USO group and 1.1 mm positive in the DRO group. There was 1 reoperation following USO for painful nonunion, while there were 2 reoperations following DRO for persistent ulnar impaction. Conclusions: An improvement in range of motion, grip strength, and VAS with restoration of the radioulnar length relationship was observed in both cohorts. USO is a simpler procedure with a shorter tourniquet time that can be an attractive alternative to DRO for ulnar impaction syndrome after distal radius malunions.

Comparison of three dimensional and radiographic measurements in the analysis of distal radius malunion

2012 ◽  
Vol 38 (2) ◽  
pp. 133-143 ◽  
Author(s):  
J. Miyake ◽  
T. Murase ◽  
Y. Yamanaka ◽  
H. Moritomo ◽  
K. Sugamoto ◽  
...  
Keyword(s):  
Distal Radius ◽  
Three Dimensional ◽  
Ulnar Variance ◽  
Radiographic Evaluation ◽  
Unaffected Side ◽  
Radiographic Measurements ◽  
Distal Radius Malunion ◽  
The Difference ◽  
Positive Correlations ◽  
Radius Malunion

To estimate the accuracy of radiographic deformity evaluation for distal radius malunion, we compared the results obtained from radiographic measurements (palmar tilt, radial angle, and ulnar variance) with those from the three-dimensional (3D) method using computer bone models in 20 dorsally tilted malunions. Dorsal tilt deformity, radial tilt deformity, and shortening deformity were calculated using the unaffected side as a reference. The 3D method showed a slightly lower value for dorsal tilt deformity than the radiographic evaluation, but the difference was < 10° in all cases. In patients with dorsal tilt ≥ 40°, notable differences in radial tilt evaluation were observed between the two methods compared with patients with less dorsal tilt. The 3D shortening showed positive correlations with radiographic evaluation, but a discrepancy of ≥ 2 mm was observed in eight cases. Palmar tilt is reliable for surgical planning, but radial angle and ulnar variance may be less accurate than previously thought.

Corrective Osteotomy for Combined Intra- and Extra-articular Distal Radius Malunion

2012 ◽  
Vol 37 (10) ◽  
pp. 2041-2049 ◽  
Author(s):  
Geert A. Buijze ◽  
Karl-Josef Prommersberger ◽  
Juan González del Pino ◽  
Diego L. Fernandez ◽  
Jesse B. Jupiter
Keyword(s):  
Distal Radius ◽  
Corrective Osteotomy ◽  
Distal Radius Malunion ◽  
Radius Malunion
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