Corrective osteotomy for malunited, volarly displaced fractures of the distal end of the radius

Wrist fractures

The benefits of a well-reduced and well-healed wrist fracture are predictable. This knowledge has prompted the development of myriad treatment methods and fixation devices. The choice of open versus closed reduction and the devices used to maintain that reduction could most often be determined with a well-defined and reproducible closed reduction maneuver. With this maneuver, the integrity of the critical volar ulnar corner of the radius is determined as is articular stepoff, metaphyseal comminution, and distal radionular joint (DRUJ) stability. Reconstruction of the subluxed or dislocated DRUJ starts with the reduction of the radius, frequently obviating the need to address fractures involving the ulnar head and styloid. Most importantly, the results of treatment reflect surgical decision over the fixation method.

Corrective osteotomy for symptomatic increased ulnar tilt of the distal end of the radius

Twelve wrists in 10 patients with a mean age of 23.6 years were treated for symptomatic increased ulnar inclination of the joint surface with corrective osteotomy of the radius. Diagnoses included mild ulnar dysplasia, posttraumatic deformity, Madelung's disease, and multiple hereditary exostosis. All patients had radial-sided wrist pain and an ulnarly displaced arc of radioulnar deviation. Preoperative radiographs showed excessive ulnar inclination of the distal radius, ulnar carpal translation, adaptive carpal malalignment, and frequent distal radioulnar joint incongruency. The patients had decreased pain and improved wrist function at a mean of 5.1 years (range, 2-10 years) after surgery. Average radial deviation changed from 3 degrees to 16 degrees and ulnar deviation from 48 degrees to 29 degrees; flexion/extension and pronosupination remained unchanged. Realignment of the wrist was shown radiographically by a change of ulnar inclination of the radius from 33 degrees to 21 degrees, an increase in scaphoid height from 16.4 to 20.4 mm, and reversal of ulnar carpal translation as shown by an increase in lunate-covering ratio of 64% to 77%. Reduction of the ulnar inclination to normal values by corrective radial osteotomy restores a more physiologic range of motion, decreases symptomatic wrist pain, reverts adaptive carpal changes to normal, increases lunate coverage, and may prevent abnormal cartilage overload in the ulnar compartment of the wrist.