Elsevier

The Journal of Hand Surgery

Volume 37, Issue 10, October 2012, Pages 2041-2049
The Journal of Hand Surgery

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

https://doi.org/10.1016/j.jhsa.2012.07.013Get rights and content

Purpose

This study evaluated the functional outcome of corrective osteotomy for combined intra- and extra-articular malunions of the distal radius using multiple outcome scores.

Methods

We evaluated 18 skeletally mature patients at an average of 78 months after corrective osteotomy for a combined intra- and extra-articular malunion of the distal part of the radius. The indication for osteotomy in all patients was the combination of an extra-articular deformity (≥ 15° volar or ≥ 10° dorsal angulation or ≥ 3 mm radial shortening) and intra-articular incongruity of 2 mm or greater (maximum stepoff or gap), as measured on lateral and posteroanterior radiographs. The average interval from the injury to the osteotomy was 9 months. The average maximum stepoff or gap of the articular surface before surgery was 4 mm.

Results

All 18 patients healed uneventfully and the final articular incongruity was reduced to 2 mm or less. Final range of motion and grip strength significantly improved, averaging 89% and 84% of the uninjured side and 185% and 241% of the preoperative measures, respectively. The rate of excellent or good results was 72% according to the validated rating system Mayo Modified Wrist Score, and 89% according to the unvalidated system of Gartland and Werley. The mean Disabilities of the Arm, Shoulder, and Hand score was 11, which corresponds to mild perceived disability. Of the 18 cases, 11 normalized upper limb function. Five patients had complications; all were successfully treated. According to the rating system of Knirk and Jupiter, 4 had grade 1 and 1 had grade 2 osteoarthritis of the radiocarpal joint on radiographs. Two of those patients reported occasional mild pain. Radiographic osteoarthritis did not correlate with strength, motion, and wrist scores.

Conclusions

Outcomes of corrective osteotomy for combined intra- and extra-articular malunions were comparable to those of osteotomy for isolated intra- and extra-articular malunions. A successful corrective osteotomy for the treatment of complex intra- and extra-articular distal radius malunions can improve wrist function.

Type of study/level of evidence

Therapeutic IV.

Section snippets

Patients

Between 1998 and 2009, we treated 21 consecutive adult patients for combined intra- and extra-articular distal radius malunions at 1 of 4 institutions. All patients were invited to return for assessment of the wrist after a minimum of 2 years after osteotomy. Two patients had died of unrelated causes, 1 patient did not have 2 years of follow-up, and 18 patients returned. Prior data of 6 of the 18 patients were reported previously as part of a clinical outcome study of intra-articular distal

Results

The mean duration of follow-up was 78 months (median, 88 months; range, 24–134 months). The osteotomy healed uneventfully in all 18 patients (Fig. 5). All measurements of final range of motion and grip strength compared with preoperative measures and to the contralateral arm significantly (P < .05) improved as a result of the corrective osteotomy (Table 1). All patients expressed high satisfaction with the final outcome, even the patient who scored a poor outcome on the MMWS because of limited

Discussion

The present study showed that a corrective osteotomy for combined intra- and extra-articular distal radius malunion can effectively improve wrist function with reproducible results and a high subjective satisfaction rate. Similar to previous series, failure of the procedure (considered as osteonecrosis at the osteotomy site or early partial radioscapholunate or total wrist arthrodesis) did not occur; these failures are considered rare complications.2, 4, 5, 9 Hardware removal occurred at a high

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