Open wedge corrective osteotomy of malunited distal radius fractures through a palmar approach A retrospective analysis

The conservative as well as the operative treatment of distal radius fractures poses a risk of inadequate reduction or secondary dislocation. The consequences may be limited use of the hand with pain and restricted movement. Out of 21 patients with malunited fractures of the distal radius which were corrected operatively through a palmar approach, 19 have been assessed clinically as well as radiologically. The mean age was 60 years (range 45-84 years) and the mean follow-up period was 342 days. In 10 cases no autologous bone graft was inserted into the osteotomy gap. Postoperatively the average extension was 51.8A degrees (+/- 14.9A degrees) and flexion 53.5A degrees (+/- 14A degrees) as well as a supination of 83.8A degrees (+/- 11.2A degrees) and pronation of 84.7A degrees (+/- 12A degrees). The wrist score averaged 85 points, the disabilities of the arm, shoulder and hand (DASH) functional value averaged 17 points. A mean preoperative palmar inclination of -20.9A degrees (+/- 10.1A degrees) improved to 5.4A degrees (+/- 3.8A degrees) after surgery and the ulnar inclination from 9A degrees (+/- 8.5A degrees) to 18.1A degrees (+/- 6.2A degrees). The correction of malunited distal radius fractures led to an improvement in function with less pain. Our data indicate that under certain circumstances interposition of an autologous bone graft does not need to be performed.