Opening Wedge Osteotomy for Distal Radius Malunion: Dorsal or Palmar Approach?

Abstract

Background?There are various technical variations to consider when performing a corrective osteotomy of a distal radius malunion. We chose two of the more commonly reported techniques and compared the results of volar (palmar) osteotomy and fixation with dorsal osteotomy and fixation. Method?Within a continuous cohort of patients who had undergone corrective osteotomy for a malunited Colles fracture, two groups could be identified retrospectively. In 8 patients a dorsal approach was used. A structural trapezoidal graft, subtending the amount of correction, was inserted into the osteotomy gap and stabilization was performed with a thin round-hole mini-fragment plate. In 14 patients a palmar approach and a palmar fixed-angle plate was used for correction of the malunion and for angular stable rigid fixation of the two fragments. The osteotomy gap was loosely filled with nonstructural cancellous bone chips. A retrospective comparison of the two groups was performed to see whether the outcome was affected by the use of either operative technique.The demographics, the preoperative amount of deformity, range of motion, pain, and force were comparable for both groups. All osteotomies healed without loss of correction. After a minimal follow-up of one year, radiographic appearance, objective functional parameters were assessed and subjective data (Disabilities of the Arm, Shoulder, and Hand [DASH] score and special pain and function questionnaire) obtained. Results?These data did not show statistical difference for the two groups except for the amount of final wrist flexion. This parameter was significantly better in patients who had palmar approaches and fixed-angle plates. Conclusion?Corrective osteotomies of distal radius malunions can be done in either way. It might result in some better flexion, if performed volarly.

Corrective osteotomies of the radius: Grafting or not?

“…The authors came to the concept that the stiff characteristics of fixed angle volar plates could provide an alternative to the traditional techniques of distal radius osteotomy including structural bone grafting and dorsal plate fixation or external fixation. Comparable results in terms of anatomic restoration of the distal radius, ROM improvement in the radiocarpal joint, and restoration of the anatomic relationships of the distal radioulnar join were obtained by Rothenfluh et al [29] , Wada et al [23] , and Peterson et al [28] . All these authors used bone graft from the iliac crest with a comparable DASH scores and no complications.…”

“…The healing time was comparable using the graft or not (mean 12.5 wk), ranging from 7.5 [24] to 16 [25,26] wk. The mean DASH score improvement was 23 points both in the studies describing the use of the graft (range, 11-46) [22][23][24][27][28][29] , and in those not using the graft (range, 13-28) [25,[30][31][32] . Finally, few studies reported postoperative complications [11,22,23,26,29,32] .…”

“…Only Rothenfluh et al [29] reported in one case a secondary dislocation of the distal fragment observed 21 d after volar osteotomy. In his study Rothenfluh et al [29] compared the results of dorsal approach plus structural trapezoidal bone graft stabilized using a thin round-hole mini-fragment plate, with palmar approach plus nonstructural cancellous bone chips and a palmar fixed-angle plate, suggesting comparable results to those achieved with dorsal osteotomy and the interposition of cortico-cancellous bone graft. However, the palmar approach determined a more favorable effect on wrist flexion, entailing lower complication rates, mainly represented by extensor tendonitis and hardware removal.…”

Outcome of Distal Radius Malunions Managed by Corrective Osteotomy by Volar Approach- A Clinical and Radiological Study

“…Rothenfluh et al group have compared dorsal and volar approaches for distal radius malunion and cited the benefits of volar approach like low tendon irritation problems and easy learning curve. 14 Jupiter and Ring demonstrated that performing early osteotomy facilitates the surgical procedure (osteotomy by means of immature bone tissue with less soft tissue retraction and less instability of the distal radioulnar joint) and diminishes the time off work. 15,16 For this reason, young patients with dorsal angulation greater than 20 degrees should be considered to be in a precursor situation of the degenerative process (arthrosis) and a surgical procedure should be indicated.…”

Anatomical reduction and precise internal fixation of intra-articular fractures of the distal radius with virtual X-ray and 3D printing

“…Intra-articular DRF (IDRF), a severe form of DRF, accounts for about 25% of total DRF [3]. Currently, it is still very challenging to completely recover from the IDRF, because it is necessary to achieve not only an anatomical reduction [4,5], i.e., complete reconstruction of radius and the articular surface [6], but also a strong and precise internal fixation to facilitate early rehabilitation [7]; otherwise complications such as traumatic arthritis will often occur, which will seriously affect the function of the hands and wrists [8,9].…”