Osteotomy of dorsally displaced malunited fractures of the distal radius: No loss of radiographic correction during healing with a minimally invasive fixation technique and an injectable bone substitute

Abstract

Background and purpose Malunion after a distal radius fracture can be treated with an osteotomy of the distal radius. Often autologous iliac crest bone graft is used to fill the gap, but this is associated with donor site morbidity. Instead of bone graft, we have used a slow-resorbing bone substitute in combination with a minimally invasive fixation technique.

Patients and methods 25 consecutive patients with a dorsal malunion after a distal radius fracture underwent an osteotomy. A TriMed buttress pin and a radial pin plate were used for fixation, and Norian SRS as bone substitute. The patients were followed for a minimum of 1 year and range of motion, grip strength, DASH scores, and the radiographic correction were measured.

Results Forearm rotation improved from 137° to 155°, flexion/extension from 102° to 120°, and radioul-nar deviation from 32° to 43°. Grip strength increased from 62% of the contralateral hand to 82%. DASH scores decreased from 36 to 23. Radiographically, all osteotomies but 1 healed and the radiographic correction achieved was consistent over the first year.

Interpretation Osteotomy of the distal radius is effective in increasing motion and grip strength after a malunited distal radial fracture. Patient satisfaction is high and subjective results measured with DASH are good. Using a bone substitute, the operation can be performed as an outpatient procedure and donor-site pain avoided. No loss of the radiographic correction achieved was noted during osteotomy healing.

Contributions of authors

AA reviewed the literature, planned and performed the study, and wrote the manuscript. MT participated in planning and performing the study and in writing the manuscript. MG performed the radiological measurements and revised the manuscript. PK planned and performed the study and revised the manuscript.The authors wish to thank occupational therapists Margareta Wollmark and Ulrika Wijk for excellent assistance. The project was supported by Region Skåne, Lund University Hospital, the Alfred Österlund Foundation, the Greta and Johan Kock Foundation, the Crafoord Foundation, the Maggie Stephens Foundation, Swedish Research Council—Medicine (09509), Stiftelsen för Bistånd åt Rörelsehindrade i Skåne, and by the Medical Faculty of Lund University.