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

Figures & data

Figure 1. A. Dorsal buttress pin with washer and bicortical screw. B. Radial pin plate with pins and screws. C. Preoperative radiograph. D. The fixation device and the bone substitute in place.

Figure 2 A. The operation was carried out with the arm in a prone position. 2 short incisions were made, one radially through the first extensor compartment and a second dorsal incision through the fourth compartment. B. The joint line was marked with 2 parallel pins into the distal radius and the holes were later used for the dorsal buttress pin. C. The osteotomy was then performed with an oscillating saw and the malposition reduced. A temporary fixation was achieved by a pin driven through the radial styloid and into the radius, proximal to the osteotomy, thereby bridging the osteotomy. D. When optimal positioning was accomplished, the fixation was secured by the dorsal buttress pin and the radial pin plate (E). F. Norian SRS was injected into the bone defect and left to harden as the extensor retinaculum and skin were closed. A bulky dressing and a dorsal cast completed the operation.

Table 1. Radiographic parameters preoperatively, postoperatively, and at final follow-up

		Preoperatively	Postoperatively		1 year
	n	mean (SD)	mean (SD)	P-value^a	mean (SD)	P-value^b
Axial compression (mm)	24	4.0 (2.2)	2.6 (2.1)	< 0.001	2.5 (2.1)	0.8
Radial inclination (degrees)	23	20 (9.8)	21 (3.8)	0.6	22 (4.2)	0.2
Dorsal angulation (degrees)	24	17 (9.6)	−0.1 (10)	< 0.001	0.0 (11)	0.5

^a p-value comparing the preoperative value to the immediate postoperative value.

^b p-value comparing the postoperative value to the value at final follow-up 1 year postoperatively.

Table 2. Objective results

		Preoperativ	1 year^a
	n	mean (SD)	mean (SD)	P-value
Forearm rotation (degrees)	23	137 (33)	156 (25)	0.006
Radio-ulnar deviation (degrees)	23	32 (1.8)	43 (10.3)	0.001
Extension/flexion (degrees)	23	103 (20)	120 (16)	< 0.001
Grip strength (%)^b	22	62 (19)	82 (20)	< 0.001

^a or last follow-up

^b percentage of uninjured side

Table 3. Subjective measures preoperatively, at 3 months, and at 1 year postoperatively

	Preoperatively		3 months			1 year
	mean (SD)	median	mean (SD)	median	P-value^a	mean (SD)	median	P-value^b
Pain at rest ^c	3.8 (2.2)	4	2.0 (1.7)	2	0.004	2.0 (1.6)	3	0.003
Pain during activity ^c	6.3 (2.3)	7	4.5 (2.9)	4	0.02	3.8 (2.4)	4	0.001
DASH^d	36 (16)	39	25 (16)	21	0.02	23 (19)	21	0.003

^a p-value comparing preoperative results to the 3-month results.

^b p-value comparing preoperative results to the results at final follow-up.

^c VAS (0–10 cm: 0 = no symptoms; 10 = worst possible symptoms).

^d DASH scale (0–100: 0 = no symptoms; 100 = worst possible symptoms).