Opening Wedge Osteotomy and Bone Grafting for Distal 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.