Dorsally and volarly angulated extra-articular malunions of the distal radius treated with volar corrective osteotomy and volar locking plate fixation. A case series of 19 patients with a long-term follow-up

Main Article Content

Agostino Di Maro
Matteo Meroni
Placido Stissi
Michele Francesco Surace
Mario Cherubino
Alessandro Fagetti

Keywords

Extra-articular fracture, Distal radius malunion, Volar and dorsal deformity, Corrective osteotomy, Volar locking plate

Abstract

Background and aim: To date, different technique of corrective osteotomy for the treatment of distal radius extra-articular malunions are described. With this study, we present a case series of corrective osteotomy using volar plate fixation to treat volar and dorsal extra-articular malunions aiming to evaluate the effectiveness of corrective osteotomies through volar plate stabilization in these two types of extra-articular malunions.


Methods: Between August 2008 and May 2017 all patients diagnosed with extra-articular malunion were included in the study. An extended volar Orbay approach and two types of dedicated volar locking plate (Medartis AG, Switzerland and Acumed, Hillsboro,OR) were used. Clinical and radiological parameters were evaluated. The DASH and PRWE scores and the VAS scale questionnaires were administered. The results were analyzed through statistical evaluations.


Results: A retrospective analysis of 19 patients diagnosed with extra-articular malunion was carried out. Nine had a volar type deformity (group A), while the other 10 had a dorsal type deformity (group B). The active range of motion (aROM), radiographic parameters, grip strength and pinches in both groups were statistically improved, except for radial deviation in both groups, ulnar deviation in group A, and radial inclination in group B.  The grip strength and pinches values were slightly better in group A. DASH, PRWE scores and VAS scale showed a significant improvement.


Conclusion: Corrective osteotomy through volar fixation is an effective technique to treat both extra-articular dorsally and volarly angulated malunions. Statistically significant benefits are present in both types of deformities, with better outcomes in the group of volar deformities.

Downloads

Download data is not yet available.
Abstract 79 | PDF Downloads 58

References

1. Lodha SJ, Wysocki RW, Cohen MS. Malunions of the distal radius. Hand surgery update V. Am Soc Surg Hand, Rosemont. 2011:125-37.
2. Evans BT, Jupiter JB. Best Approaches in Distal Radius Fracture Malunions. Curr Rev Musculoskelet Med. 2019;12(2):198-203. doi:10.1007/s12178-019-09540-y
3. Prommersberger KJ, Lanz UB. Corrective osteotomy of the distal radius through volar approach. Tech Hand Up Extrem Surg. 2004;8(2):70-77. doi:10.1097/01.bth.0000126572.28568.88
4. Prommersberger KJ, Pillukat T, Mühldorfer M, van Schoonhoven J. Malunion of the distal radius. Arch Orthop Trauma Surg. 2012 May;132(5):693-702. doi: 10.1007/s00402-012-1466-y. PMID: 22294090.
5. Fernandez DL. Radial osteotomy and Bowers arthroplasty for malunited fractures of the distal end of the radius. J Bone Joint Surg Am. 1988;70(10):1538-1551.
6. Jupiter JB, Ring D. A comparison of early and late reconstruction of malunited fractures of the distal end of the radius. J Bone Joint Surg Am. 1996;78(5):739-748. doi:10.2106/00004623-199605000-00014
7. Osada D, Kamei S, Takai M, Tomizawa K, Tamai K. Malunited fractures of the distal radius treated with corrective osteotomy using volar locking plate and a corticocancellous bone graft following immediate mobilisation. Hand Surg. 2007;12(3):183-190. doi:10.1142/S0218810407003560
8. Henry M. Immediate mobilisation following corrective osteotomy of distal radius malunions with cancellous graft and volar fixed angle plates. J Hand Surg Eur Vol. 2007;32(1):88-92. doi:10.1016/j.jhsb.2006.09.002
9. Ring D. Treatment of the neglected distal radius fracture. Clin Orthop Relat Res. 2005;(431):85-92. doi:10.1097/01.blo.0000152442.66083.ff
10. Tiren D, Vos DI. Correction osteotomy of distal radius malunion stabilised with dorsal locking plates without grafting. Strategies Trauma Limb Reconstr. 2014;9(1):53-58. doi:10.1007/s11751-014-0190-2
11. Tang JB, Giddins G. Why and how to report surgeons' levels of expertise. J Hand Surg Eur Vol. 2016;41(4):365-366. doi:10.1177/1753193416641590
12. Graham TJ. Surgical Correction of Malunited Fractures of the Distal Radius. J Am Acad Orthop Surg. 1997;5(5):270-281. doi:10.5435/00124635-199709000-00005
13. Nana AD, Joshi A, Lichtman DM. Plating of the distal radius. J Am Acad Orthop Surg. 2005;13(3):159-171. doi:10.5435/00124635-200505000-00003
14. Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am. 2002;27(2):205-215. doi:10.1053/jhsu.2002.32081
15. Ozer K, Chung KC. The use of bone grafts and substitutes in the treatment of distal radius fractures. Hand Clin. 2012;28(2):217-223. doi:10.1016/j.hcl.2012.02.004
16. Haghverdian JC, Hsu JY, Harness NG. Complications of Corrective Osteotomies for Extra-Articular Distal Radius Malunion. J Hand Surg Am. 2019;44(11):987.e1-987.e9. doi:10.1016/j.jhsa.2018.12.013
17. Krimmer H, Schandl R, Wolters R. Corrective osteotomy after malunited distal radius fractures. Arch Orthop Trauma Surg. 2020;140(5):675-680. doi:10.1007/s00402-020-03370-1
18. Katt B, Seigerman D, Lutsky K, Beredjiklian P. Distal Radius Malunion. J Hand Surg Am. 2020;45(5):433-442. doi:10.1016/j.jhsa.2020.02.008
19. Smaby N, Johanson ME, Baker B, Kenney DE, Murray WM, Hentz VR. Identification of key pinch forces required to complete functional tasks. J Rehabil Res Dev. 2004;41(2):215-224. doi:10.1682/jrrd.2004.02.0215
20. Delclaux S, Trang Pham TT, Bonnevialle N, et al. Distal radius fracture malunion: Importance of managing injuries of the distal radio-ulnar joint. Orthop Traumatol Surg Res. 2016;102(3):327-332. doi:10.1016/j.otsr.2015.12.010
21. Mahmoud M, El Shafie S, Kamal M. Correction of dorsally-malunited extra-articular distal radial fractures using volar locked plates without bone grafting. J Bone Joint Surg Br. 2012;94(8):1090-1096. doi:10.1302/0301-620X.94B8.28646
22. Tarallo L, Mugnai R, Zambianchi F, Adani R, Catani F. Volar plate fixation for the treatment of distal radius fractures: analysis of adverse events. J Orthop Trauma. 2013;27(12):740-745. doi:10.1097/BOT.0b013e3182913fc5
23. Rozental TD, Beredjiklian PK, Bozentka DJ. Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal part of the radius. J Bone Joint Surg Am. 2003;85(10):1956-1960. doi:10.2106/00004623-200310000-00014
24. Malone KJ, Magnell TD, Freeman DC, Boyer MI, Placzek JD. Surgical correction of dorsally angulated distal radius malunions with fixed angle volar plating: a case series. J Hand Surg Am. 2006;31(3):366-372. doi:10.1016/j.jhsa.2005.10.017
25. Rothenfluh E, Schweizer A, Nagy L. Opening wedge osteotomy for distal radius malunion: dorsal or palmar approach? . J Wrist Surg. 2013;2(1):49-54. doi:10.1055/s-0032-1326725
26. Oka K, Kataoka T, Tanaka H, Okada K, Yoshikawa H, Murase T. A comparison of corrective osteotomies using dorsal and volar fixation for malunited distal radius fractures. Int Orthop. 2018;42(12):2873-2879. doi:10.1007/s00264-018-3972-1
27. Schurko BM, Lechtig A, Chen NC, et al. Outcomes and Complications Following Volar and Dorsal Osteotomy for Symptomatic Distal Radius Malunions: A Comparative Study. J Hand Surg Am. 2020;45(2):158.e1-158.e8. doi:10.1016/j.jhsa.2019.05.015
28. Tarallo L, Mugnai R, Adani R, Catani F. Malunited extra-articular distal radius fractures: corrective osteotomies using volar locking plate. J Orthop Traumatol. 2014;15(4):285-290. doi:10.1007/s10195-014-0307-x
29. Sato K, Nakamura T, Iwamoto T, Toyama Y, Ikegami H, Takayama S. Corrective osteotomy for volarly malunited distal radius fracture. J Hand Surg Am. 2009;34(1):27-33.e1. doi:10.1016/j.jhsa.2008.09.018
30. Krzyżańska L, Straburzyńska-Lupa A, Rąglewska P, Romanowski L. Beneficial Effects of Pulsed Electromagnetic Field during Cast Immobilization in Patients with Distal Radius Fracture. Biomed Res Int. 2020;2020:6849352. Published 2020 Feb 25. doi:10.1155/2020/6849352

Most read articles by the same author(s)