Long-term outcomes of corrective osteotomy for malunited fractures of the distal radius

Andreasson, Ingrid; Kjellby-Wendt, Gunilla; Fagevik-Olsén, Monika; Aurell, Ylva; Ullman, M. David; Karlsson, Jón

doi:10.1080/2000656x.2019.1693392

Cited by 15 publications

(11 citation statements)

References 30 publications

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“…The observed PROMs reported in our study are consistent with previous data reporting on the outcome of USO [12,14,15,17]. Moreover, these PROMs are comparable with those published following DRO, including PRWE (11 in our cohort vs. 12 to 22 in DRO [6,24,25]), QuickDASH (6.8 in our cohort vs. 10 to 16 in DRO [6,25,26], EQ-5D-5L (0.88 in our cohort vs. 0.84 in DRO [6]), satisfaction rate (84% in our cohort vs. 83% in DRO [6]), and NPS (73 in our cohort vs. 69 in DRO [6]. However, in the absence of preoperative data we are unable to comment on the degree of preoperative disability in patients whose predominant symptoms are due to ulnar positive variance.…”

Section: Discussionsupporting

confidence: 92%

Distal radius malunion: outcomes following an ulnar shortening osteotomy

Stirling

Oliver

et al. 2022

Eur J Orthop Surg Traumatol

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Purpose Positive ulnar variance following a distal radius malunion can lead to ulnar-sided wrist pain, loss of grip strength, and distal radioulnar joint impingement. The primary aim of this study is to describe upper limb-specific functional outcomes following ulnar shortening osteotomy (USO) for ulnar-sided wrist pain associated with malunion of the distal radius. Methods We retrospectively identified 40 adult patients from a single centre over a 9-year period that had undergone an USO for symptomatic malunion of the distal radius. The primary outcome was the patient-rated wrist evaluation (PRWE). Secondary outcomes were the QuickDASH, EQ-5D-5L, complications, and net promoter score (NPS). Results Outcomes were available for 37 patients (93%). The mean age was 56 years and 25 patients were female (68%). At a mean follow-up of 6 years (range 1–10 years) the median PRWE was 11 (IQR 0–29.5), the median QuickDASH 6.8 (IQR 0–29.5), and the median EQ-5D-5L index was 0.88 (IQR 0.71–1). The NPS was 73. Complications occurred in nine patients (24%) and included non-union (n = 4), early loss of fixation requiring revision surgery (n = 1), superficial wound infection (n = 2), neurological injury (n = 1), and further surgery for symptomatic hardware removal (n = 1). Conclusions For patients with a symptomatic distal radius malunion where the predominant deformity is ulnar positive variance, this study has demonstrated that despite 1 in 4 patients experiencing a complication, USO can result in excellent patient reported outcomes with high levels of satisfaction. Level of Evidence III (Cohort Study).

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Section: Discussionsupporting

confidence: 92%

Distal radius malunion: outcomes following an ulnar shortening osteotomy

Stirling

Oliver

et al. 2022

Eur J Orthop Surg Traumatol

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“…All patients experienced some degree of pain after the surgery. They suggested corrective osteotomy for patients with a poor functional outcome after a distal radius fracture [13]. According to the patients' report, none of the patients had experienced pain until the last follow-up.…”

Section: Andreasson Et Al Reported the Outcome Of Correctivementioning

confidence: 99%

Corrective Osteotomy With K-Wire Fixation For the Treatment of Symptomatic Distal Radius Extra-Articular Malunion

Shariatzade

Mazhar

Barkam

et al. 2021

J. Res. Orthop. Sci.

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Background: Optimization of the corrective osteotomy for the treatment of distal radius extra-articular ‎ ‎malunion is an ‎ongoing project‎‏. Objectives: In this study, ‏we aimed to evaluate the outcome of corrective osteotomy ‎with K-wire fixation in the treatment of patients with symptomatic distal radius extra-articular malunion.‎ Patients & Methods: Twenty-three patients with symptomatic distal radius extra-articular malunion, mean ‎age of ‎38.3±7.6‎‏ years‎, ‎and a mean follow‎-‎up of ‏‎34.4±11.3 months‎‏ were included‎. ‎Corrective osteotomy ‏was performed through a dorsal approach and using K‎-‎wire instead of the plate for the fixation ‏of the osteotomy site‎. ‎The outcome was assessed with radiographic measures including ‏ulnar ‎variance, radial tilt, radial inclination angle, radial height, and clinical measures including ‎wrist range of motion, the short form of Disabilities of the Arm, Shoulder, and ‎Hand (Quick-‎DASH), and the Modified Mayo Wrist Score (MMWS).‎ Results: Radiographic measures and wrist range of motion in all directions were significantly improved at the last follow-up. The mean final Quick-DASH score of the patients was 16.3±8. The mean final MMWS was 92.2±13.5. According to the MMWS, 9 (39.1%) patients had an excellent function, 13 (56.5%) patients had a good function, and one (4.4%) patient had a fair function. Radiographic union was observed in all wrists within an average period of 10.2±4 weeks. No postoperative complication was recorded. Conclusion: Since K-wire fixation is less expensive, requires smaller incision, and provides acceptable radiologic and clinical outcomes, it could be regarded as a good alternative for plate fixation in corrective osteotomy for distal radius extra-articular malunion.

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“…Ingrid Andreasson et al . reported good long‐term follow‐up outcomes for 37 patients with malunited fractures of distal radius who underwent corrective osteotomy using a volar plate 10 . Similarly, Kunihiro et al .…”

Section: Introductionmentioning

confidence: 99%

“…An increasing body of evidence suggests that corrective osteotomy with volar fixation is an effective method for treating distal radius fracture malunion due to its unique advantages, accounting for its increasing use by orthopaedists 2,8,9 . Ingrid Andreasson et al reported good long-term follow-up outcomes for 37 patients with malunited fractures of distal radius who underwent corrective osteotomy using a volar plate 10 . Similarly, Kunihiro et al reported that volar fixation had lower surgical technical requirements and fewer complications than dorsal fixation 11 .…”

Section: Introductionmentioning

confidence: 99%

Corrective Osteotomy with Volar and Dorsal Fixation for Malunion of Intra‐Articular Fracture of the Distal Radius: A Retrospective Study

Zhang

Zhu

et al. 2022

Orthopaedic Surgery

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Objectives Although corrective osteotomy with volar or dorsal plate fixation can treat malunion of distal radius fractures, each has its own disadvantages. Little is currently known on whether dorsal fixation combined with volar fixation may further improve recovery. This study aimed to evaluate the clinical value of corrective osteotomy combined with volar and dorsal plate fixation in patients with malunion of intra‐articular fractures of the distal radius. Methods Seventeen patients with malunion of intra‐articular fractures of the distal radius treated with corrective osteotomy with volar and dorsal plate fixation from 1 January 2016 to 31 November 2018 were retrospectively analyzed. The enrolled patients included seven males and 10 females with an average age of 54.9 years (range: 36–70 years). The radiographic parameters, including the radial length, the radial inclination angle, the ulnar variance, and the volar tilt, as well as clinical outcomes, including wrist and forearm range of motion (ROM), grip strength, the Mayo Modified Wrist Score (MMWS), and the disabilities of the Arm, Shoulder, and Hand (DASH) score, were examined at 3 months and 18 months after operation and compared with the preoperative state. The paired t ‐test was used for statistical analysis. Results After corrective osteotomy combined with volar and dorsal plate fixation, all included patients were followed up for 18 months, and there was no surgical site infection. Patients reported postoperative pain due to the irritation of extensor tendon (two cases) and wrist arthritis (two cases). The radial length increased from 1.34 ± 2.34 mm to 9.25 ± 2.65 mm and 9.03 ± 2.47 mm at 3 months and 18 months postoperatively ( t = 8.257, 7.954, all p < 0.05). The radial inclination angle increased from 6.45° ± 0.76° to 19.35° ± 3.43° and 19.03° ± 3.63° at 3 and 18 months ( t = 12.517, 12.122, all p < 0.05). The ulnar variance decreased from 5.11 ± 0.23 mm to 1.32 ± 0.31 mm and 1.54 ± 0.62 mm at 3 and 18 months ( t = 4.214, 4.895, all p < 0.05). The volar tilt was corrected from 4.47° ± 3.46° to 15.51° ± 2.72° and 14.12° ± 2.41°, respectively ( t = 11.247, 10.432, all p < 0.05). Moreover, wrist ROM increased from 42.53° ± 8.99° to 98.70° ± 7.61° and 101.24° ± 7.66° ( t = 41.433, 46.627, all p < 0.05), while forearm ROM was increased from 94.82° ± 6.54° to 134.47° ± 5.06° and 137.24° ± 5.52°, respectively ( t = 31.507, 32.584, all p < 0.05). Similarly, grip strength, MMWS, and DASH were also remarkably improved. There were no significant differences in the wrist and forearm ROM, grip strength, MMWS, and DASH scores between follow‐u...

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Long-term outcomes of corrective osteotomy for malunited fractures of the distal radius

Cited by 15 publications

References 30 publications

Distal radius malunion: outcomes following an ulnar shortening osteotomy

Distal radius malunion: outcomes following an ulnar shortening osteotomy

Corrective Osteotomy With K-Wire Fixation For the Treatment of Symptomatic Distal Radius Extra-Articular Malunion

Corrective Osteotomy with Volar and Dorsal Fixation for Malunion of Intra‐Articular Fracture of the Distal Radius: A Retrospective Study

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