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Liu TY, Yang CY. Management of Extra-Articular and Intra-Articular Distal Radius Malunion. Life (Basel) 2024; 14:1177. [PMID: 39337960 PMCID: PMC11433060 DOI: 10.3390/life14091177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 09/09/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024] Open
Abstract
This article presents a comprehensive overview of managing extra-articular and intra-articular distal radius malunions (DRM), discussing the pathoanatomy, clinical, and radiologic evaluation, conservative treatment, and surgical strategies. Corrective osteotomy remains the primary surgical intervention for symptomatic DRM. Surgical planning should consider factors such as timing, approach, correction technique, implant, graft, and associated injuries. The correction of extra-articular malunion necessitates brachioradialis tenotomy, circumferential periosteum release, and intrafocal elevation with grafting to facilitate distal radius realignment following osteotomy. Computer-assisted planning with 3D-printed patient-specific instrumentation (PSI) could help execute extra-articular osteotomy with high precision. As for the management of intra-articular malunion, it may require wrist arthrotomy, arthroscopy, or PSI assistance for precise articular osteotomy and reduction of the joint surface. This review highlights the importance of early intervention, thorough preoperative planning, and appropriate surgical techniques to optimize outcomes and minimize complications. Future research should focus on large-scale randomized controlled trials to compare different surgical methods, particularly for intra-articular DRM.
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Affiliation(s)
- Ting-Yu Liu
- Department of Orthopedic Surgery, Kuang Tien General Hospital, Taichung 433401, Taiwan
- Department of Nursing, Hungkuang University, Taichung 433304, Taiwan
| | - Chen-Yuan Yang
- Department of Orthopedic Surgery, Kuang Tien General Hospital, Taichung 433401, Taiwan
- Department of Nursing, Hungkuang University, Taichung 433304, Taiwan
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Akezuma H, Kawasaki K, Okano I, Kubo K, Kudo Y. Intra- and Extra-Articular Double-Level Osteotomy for Pediatric Malunited Proximal Phalangeal Fracture: A Case Report. Cureus 2024; 16:e67229. [PMID: 39295720 PMCID: PMC11410391 DOI: 10.7759/cureus.67229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2024] [Indexed: 09/21/2024] Open
Abstract
A 13-year-old boy visited our clinic due to a malunion following a phalangeal bicondylar T-shaped fracture in the proximal interphalangeal (PIP) joint of his small finger. Imaging studies showed over 2 mm of fracture displacement and ulnar deviation of the radial condyle. The patient underwent surgical correction four weeks after the initial injury. The malunited fragments were reduced to their near-anatomical positions, and an extra-articular osteotomy was performed to realign the angular deformity. Solid bone union was successfully achieved eight weeks after the corrective surgery. This intra- and extra-articular double-level osteotomy is a good option for pediatric phalangeal bicondylar T-shaped malunions.
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Affiliation(s)
- Hirotaka Akezuma
- Department of Orthopedics, Showa University Northern Yokohama Hospital, Kanagawa, JPN
| | - Keikichi Kawasaki
- Department of Orthopedics, Showa University Northern Yokohama Hospital, Kanagawa, JPN
| | - Ichiro Okano
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, JPN
| | - Kazutoshi Kubo
- Department of Orthopedics, Showa University Koto Toyosu Hospital, Tokyo, JPN
| | - Yoshifumi Kudo
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, JPN
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Geeta Anasuya D, Kumar A, Arasu S, Shanmugam J, Vijaianand M, Praveen D. Radiographic Morphometric Analysis of the Distal Radius in the Tamil Nadu Population: A Retrospective Study. Cureus 2024; 16:e62226. [PMID: 39006631 PMCID: PMC11244725 DOI: 10.7759/cureus.62226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
Background and objectives Morphometric parameters such as radial inclination, palmar tilt, radial height, and ulnar variance exhibit considerable variations influenced by geographical, ethnic, racial, and individual factors. These parameters are pivotal in the context of distal radius fractures, distal radius plate design, and kinesiology. Understanding these variations is crucial for surgical precision and predicting complications. Methods This observational, retrospective study, conducted in a single hospital, aimed to determine the morphometric values of the distal end radius, specifically in the South Indian population. We analyzed 300 plain radiographs, encompassing 53.7% males and 46.3% females, with ages ranging from 17 to 89 years (mean age: 41.05 ± 15.8). Radial inclination, radial height, palmar tilt, and ulnar variance were measured on posteroanterior views, while palmar tilt was assessed on lateral wrist X-rays. Results In our study, significant gender-based and side-specific differences were observed. The mean length of the styloid process, palmar tilt, ulnar variance, anteroposterior diameter of the radius, transverse diameter of the radius, oblique width of the radius, and carpal height of the radius exhibited notable variations between males and females. Similarly, significant differences were noted between the right and left sides concerning ulnar variance and teardrop angle. Among males, a significant difference was observed only in the teardrop angle between the right and left sides (59.11 ± 7.25 vs. 62.01 ± 7.97). Conclusion The findings underscore the importance of recognizing local morphometric variations in the South Indian population. This knowledge not only enhances the ability to restore normal alignment post-distal radius fractures but also provides fundamental values for future research endeavors within the local demographic. The study acts as a foundational resource for advancing our understanding of the normal anatomy and variations in the distal radius, facilitating improved clinical outcomes and tailored surgical interventions.
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Affiliation(s)
- Daliparthi Geeta Anasuya
- Department of Anatomy, Kovai Medical Centre and Hospital (KMCH) Institute of Health Sciences and Research, Coimbatore, IND
| | - Arun Kumar
- Department of Radiology, Kovai Medical Centre and Hospital (KMCH) Institute of Health Sciences and Research, Coimbatore, IND
| | - Sabari Arasu
- Department of Radiology, Kovai Medical Centre and Hospital (KMCH) Institute of Health Sciences and Research, Coimbatore, IND
| | - Jeevithan Shanmugam
- Department of Community Medicine, Kovai Medical Centre and Hospital (KMCH) Institute of Health Sciences and Research, Coimbatore, IND
| | - M Vijaianand
- Department of Anatomy, Kovai Medical Centre and Hospital (KMCH) Institute of Health Sciences and Research, Coimbatore, IND
| | - Duraisamy Praveen
- Department of Orthopedics, Kovai Medical Centre and Hospital (KMCH) Institute of Health Sciences and Research, Coimbatore, IND
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Rodriguez-Fontan F, Lauder A. Managing the Extra-Articular Distal Radius Malunion. Hand Clin 2024; 40:63-77. [PMID: 37979991 DOI: 10.1016/j.hcl.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Distal radius fractures are common injuries. Satisfactory outcomes are typically achieved with appropriate nonoperative or operative treatment. A proportion of these injuries develop symptomatic malunions, which may be treated surgically with distal radius corrective osteotomy. A thorough understanding of the anatomy, biomechanics, radiographic parameters, and indications is needed to provide appropriate treatment. Factors, including surgical approach, osteotomy type, use of bone graft, fixation construct, management of associated tendon and/or nerve conditions, soft tissue contracture releases, and need for ulnar-sided procedures, should be considered. A comprehensive evaluation is necessary to guide understanding for when salvage procedures may be preferred.
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Affiliation(s)
- Francisco Rodriguez-Fontan
- Department of Orthopedics, University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO 80045, USA
| | - Alexander Lauder
- Department of Orthopedics, University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO 80045, USA; Department of Orthopedics, Denver Health Medical Center, Denver, CO, USA.
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Patel H, Pundkar A, Shrivastava S, Jaiswal AM, Chandanwale R. Reconstructive Surgical Intervention for Malunited Distal End Radius and Ulna Fracture: A Case Report Demonstrating Improved Patient Outcomes. Cureus 2024; 16:e54328. [PMID: 38500902 PMCID: PMC10945463 DOI: 10.7759/cureus.54328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Abstract
This case report explores the efficacy of reconstructive surgical intervention in addressing malunited fractures of the distal end of the radius and ulna. The study presents a detailed analysis of a specific case, highlighting the surgical techniques employed and their impact on patient outcomes. The report emphasizes the importance of precision in addressing malunited fractures and showcases how the intervention led to improved patient outcomes. By documenting this case, the study contributes valuable insights into the field of orthopedic surgery, providing a basis for further research and enhancing the understanding of optimal approaches to managing such complex fractures.
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Affiliation(s)
- Hardik Patel
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Aditya Pundkar
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Sandeep Shrivastava
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Ankit M Jaiswal
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Rohan Chandanwale
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
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Nunotani M, Naito K, Nagura N, Kawakita S, Ishijima M. Locked Wire Fixator for a Distal Radius Fracture With Malunion: A Case Report. Cureus 2023; 15:e50193. [PMID: 38186455 PMCID: PMC10771860 DOI: 10.7759/cureus.50193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Surgical treatment for a distal radius fracture using a volar locking plate is difficult if the distal radius malunion remains. Therefore, a different surgical method from volar locking plate fixation should be required. We report the case of an 83-year-old woman with a left dorsal displaced distal radius fracture. However, the deformity of the volar cortex of the radius was recognized because of a previous distal radius fracture. Therefore, osteosynthesis with a locked wire fixator was performed. At 12 months after surgery, the patient has returned to daily activities without difficulty. A locked wire fixator can be useful for treating a distal radius fracture with malunion of the volar cortex of the distal radius.
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Affiliation(s)
| | - Kiyohito Naito
- Department of Orthopaedics, Juntendo University, Tokyo, JPN
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, JPN
| | - Nana Nagura
- Department of Orthopaedics, Juntendo University, Tokyo, JPN
| | - So Kawakita
- Department of Orthopaedics, Juntendo University, Tokyo, JPN
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, JPN
| | - Muneaki Ishijima
- Department of Orthopaedics, Juntendo University, Tokyo, JPN
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, JPN
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Bezirgan U, Acar E, Yoğun Y, Savran MD, Keskin ÖH, Armangil M. Nascent Malunion of Distal Radius Fractures Treated with Fixed Angled Volar Plates without Using Bone Grafts. Indian J Orthop 2023; 57:533-542. [PMID: 37006733 PMCID: PMC10050669 DOI: 10.1007/s43465-023-00864-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023]
Abstract
Purpose Malunion of the distal radius is a common complication. Using bone grafts is common to restore the bone to an acceptable level. This study aimed to verify if it is necessary to use bone grafts in nascent malunion of distal radius fractures treated with fixed angled volar plates and which radiographic parameters are essential to obtain satisfactory outcomes. Methods This single-centered prospective study included 11 patients who underwent corrective osteotomy of the radius for malunion. Patients with a metaphyseal, extraarticular osteotomy stabilized by a volar fixed angle plate within 3 months after the fracture are included. Patients underwent a standard radiological evaluation at postoperative 1 month, 3 months, 6 months, 1 year, and annually thereafter. Radial inclination, radial height, ulnar variance, and palmar tilt were measured. Wrist ranges of motion are measured throughout follow-up with a goniometer. Grip strength is measured using a Jamar Hand Dynamometer. The function is evaluated via the Gartland-Werley (GW) score and the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results The mean age of 11 patients, 9 (81.82%) males, included in the study was 41.45 ± 14.89 years. The mean post-fracture admission time is 39.3 ± 15.1 days. Radial inclination, radial length, and ulnar variance improved significantly after surgery (p = 0.0023, 0.0002, 0.0037). Radial inclination values are within normal limits for all patients at admission. The radial length was in the normal range for 72.73%, the ulnar variance was in the normal range for 72.73%, and palmar tilt was in the normal range for 100% of the patients. Extension 54.55%, flexion 72.73%, radial deviation 81.82%, ulnar deviation 63.64%, pronation 90.91%, and supination 72.73% were achieved after surgery. GW average was 3.09 ± 3.24 DASH score average was 12.24 ± 13.48. The mean grip strength was 29.27 ± 7.21 on the operated side, while it was 34.91 ± 5.32, on the healthy side, with a significant difference (p = 0.0108). Conclusion It is possible to get good results without using bone grafts in corrective osteotomy of distal radius malunions.
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Affiliation(s)
- Uğur Bezirgan
- Faculty of Medicine, Orthopedics and Traumatology Department, Ibn’i Sina Hospital, Ankara University, Hand Surgery Unit, Sıhhiye/ANKARA TR, Ankara, Turkey
| | - Erdinç Acar
- Orthopedics and Traumatology Department, Ankara City Hospital, Hand Surgery Unit, Ankara, Turkey
| | - Yener Yoğun
- Faculty of Medicine, Orthopedics and Traumatology Department, Ibn’i Sina Hospital, Ankara University, Hand Surgery Unit, Sıhhiye/ANKARA TR, Ankara, Turkey
| | - Merve Dursun Savran
- Faculty of Medicine, Orthopedics and Traumatology Department, Ankara University, Ankara, Turkey
| | - Ömer Halit Keskin
- Orthopedics and Traumatology Department, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Armangil
- Faculty of Medicine, Orthopedics and Traumatology Department, Ankara University, Hand Surgery Unit, Ankara, Turkey
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No delay in care of ambulatory orthopaedic fractures observed during the early Coronavirus-2019 pandemic: a retrospective cohort study. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Satria O, Abubakar I, Farqani S, Pratama IK. Reconstruction of intraarticular distal radius malunion with 3D printed guide and arthroscopic assisted intraarticular osteotomy. Int J Surg Case Rep 2022; 97:107391. [PMID: 35853284 PMCID: PMC9403068 DOI: 10.1016/j.ijscr.2022.107391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Distal radius fractures are one the most common upper extremity injuries, accounting for 25 % of pediatric fractures and up to 18 % of elderly fractures. Intraarticular malunion is one major complication of distal radius fractures and was reported in 0 to 33 % of total cases. It usually causes pain, deformity, limited range of motion (ROM), and loss of strength. Therefore, proper surgical management to satisfactorily unite the fragment is necessary. Case Illustrations: This is a case series of three adult male and female patients diagnosed with intraarticular distal radius fracture with malunion. They had been diagnosed based on clinical and radiological examinations. Preoperative and postoperative QuickDASH and ROM were measured. Three-dimensional printing was created for planning the osteotomy. Osteotomy was performed using arthroscopy. All patients showed QuickDASH and ROM improvement in all wrist movements. DISCUSSION The primary goal of the procedure was to restore normal anatomic alignment to improve wrist function and reduce pain. Osteotomy guided by arthroscopy planned by 3D printed surgical guide successfully reduced the malunion fracture. CONCLUSION Osteotomy assisted by arthroscopy combined with the 3D-printed surgical guide is a promising technique to restore challenging intraarticular distal radius malunion.
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Affiliation(s)
- Oryza Satria
- Department of Orthopaedic and Traumatology, Fatmawati Central General Hospital, Jakarta, Indonesia
| | - Irsan Abubakar
- Division of Orthopaedic and Traumatology, Department of Surgery, Universitas Syiah Kuala, Zainoel Abidin General Hospital, Banda Aceh, Indonesia
| | - Syahdi Farqani
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Indonesia.
| | - Irfan Kurnia Pratama
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Indonesia
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Izmalkov SN, Semenkin OM, Bratiichuk AN. Corrective Osteotomy of Malunited Fractures of the Distal Radius Using a Combined Surgical Approach. Hand (N Y) 2022; 17:740-747. [PMID: 32686500 PMCID: PMC9274874 DOI: 10.1177/1558944720939199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Malunited distal radius (DR) fractures following conservative treatment range from 6% to 80% of clinical observations. Surgical treatment is used to return the articular surface of the radius to original anatomical position and to restore the natural transfer of strength, wrist kinematics, and function of the entire hand. The aim of this research was to study and analyze the results of corrective osteotomy of malunited distal radius fractures using a combined approach. Methods: From 2008 to 2018, 43 patients with malunited DR fractures who underwent surgery using a combined approach were followed up. Long-term results (1 year after surgery) were studied in detail in 32 patients. Indications for surgery were determined taking into account, first, complaints of severe pain in the wrist during exertion, decreased hand strength, and limited mobility of the wrist. Results: Five patients (15.6%) reported a number of minor complications: intra-articular screw placement (2), incorrect reposition (1), transient neuropathy of the superficial branch of the radial nerve (1), and delayed fracture consolidation (1). In addition, another 5 patients reported the progression of wrist arthritis. Suppurations of the surgical wound and malunited fragments were not reported. Conclusions: During reconstructive interventions, a combined approach with palmar plating provides optimal conditions for corrective osteotomy, adequate reposition and plastic repair of the bone defect, and minimization of the number of complications.
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Affiliation(s)
| | - Oleg M. Semenkin
- Samara Regional Clinical Hospital named after V.D. Seredavin, Russian Federation
| | - Aleksandr N. Bratiichuk
- Samara State Medical University, Russian Federation,Aleksandr N. Bratiichuk, Department of Traumatology, Orthopaedics and Outpatient Surgery, Samara State Medical University, 89 Chapaevskaya Street, Samara 443099, Russian Federation.
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Ma HH, Chen YC, Huang HK, Huang YC, Chang MC, Wang JP. Comparing radial lengthening osteotomy with ulnar shortening osteotomy to treat ulnar impaction syndrome after distal radius fracture malunion. Arch Orthop Trauma Surg 2022; 142:525-531. [PMID: 34779886 DOI: 10.1007/s00402-021-04247-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Distal radius mal-unions often cause radius shortening and ulnar impaction syndrome. The modern treatments of ulnar impaction syndrome following distal radius mal-union are ulnar shortening osteotomy (USO) and distal radius lengthening osteotomy (DRLO). However, there are few studies to compare long-term outcomes of these two treatments. This study compares isolated USO to DRLO for the treatment of ulnar impaction syndrome following distal radius mal-union. MATERIALS AND METHODS We retrospectively reviewed 68 patients with extra-articular distal radius mal-unions treated by isolated USO in 36 patients and DRLO in 32 patients. Pain visual analog scale (VAS), wrist motion, grip strength, radiographic parameters including sigmoid inclination, DASH score, and perioperative complications were analyzed. Mean follow-up was 62.6 months. RESULTS The postoperative VAS scores for pain on exertion were less in the DRLO group than the USO group (1.2 vs. 2.8, p = 0.02). The DASH scores were 16.7 and 29.8 in the DRLO and USO groups, respectively (p = 0.02). The reduction of pain and improvement of function showed significantly better in the DRLO group. The mean operative time was shorter in the USO group. Most of the sigmoid inclinations were changed in DRLO. There were two re-operations following USO for painful nonunion and two patients had subsequent DRUJ osteoarthritis at the last follow-up. CONCLUSION Although both treatments improved range of motion, grip strength, and VAS for pain, DRLO was found in better reduction of pain and improvement of function. USO is a simpler procedure with a shorter operative time but it has an increased potential to cause subsequent osteoarthritis of the DRUJ as its incongruity of DRUJ after USO especially in reverted inclination. DRLO can be a preferred method for treating USWP in relevant distal radial mal-union.
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Affiliation(s)
- Hsuan-Hsiao Ma
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Beitou Distinct, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chou Chen
- Department of Orthopedics, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.,Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Hui-Kuang Huang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Beitou Distinct, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Orthopaedics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.,Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Yi-Chao Huang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Beitou Distinct, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Chau Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Beitou Distinct, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jung-Pan Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Beitou Distinct, Taipei, 112, Taiwan. .,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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12
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Di Maro A, Meroni M, Stissi P, Surace MF, Cherubino M, Fagetti A. 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. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022280. [PMID: 36533774 PMCID: PMC9828917 DOI: 10.23750/abm.v93i6.12901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/03/2022] [Indexed: 01/21/2023]
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.
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Affiliation(s)
- Agostino Di Maro
- Division of Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - Matteo Meroni
- Orthopaedic and Traumatology Department, Regional Hospital of Locarno, Switzerland
| | - Placido Stissi
- Division of Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - Michele Francesco Surace
- Division of Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - Mario Cherubino
- Microsurgery and Hand Surgery Unit, ASST Sette Laghi, Varese, Italy
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13
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Cognet JM, Mares O. Distal radius malunion in adults. Orthop Traumatol Surg Res 2021; 107:102755. [PMID: 33316441 DOI: 10.1016/j.otsr.2020.102755] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/15/2020] [Indexed: 02/03/2023]
Abstract
Distal radius malunion (DRMU) consists in a non-anatomical consolidation of a distal radius fracture. The resulting alteration of the articular or extra-articular radial anatomy impairs wrist function to a greater or lesser degree: Restricted ranges of motion, loss of strength, pain. There may also be nerve or tendon involvement. Adaptive carpal malalignment and ulnar-carpal impingement are also possible. Imaging assessment should at least include X-ray and CT; CT-arthrography is essential in intra-articular DRMU, which regularly progresses toward radiocarpal osteoarthritis. Surgical indications are guided by clinical assessment. Restoring distal radial anatomy requires osteotomy, according to type of DRMU: anterior or posterior opening or closing wedge. Bone or bone-substitute graft may need to be associated. Computerisation has improved planning and should be implemented, whenever possible. Ulnar osteotomy may be performed, isolated or associated to distal radial osteotomy. Palliative partial fusion or bone resection is possible in case of joint involvement or in patients with low functional demand.
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Affiliation(s)
- Jean-Michel Cognet
- SOS Mains Champagne Ardennes, clinique Courlancy, 38 bis, rue de Courlancy, 51100 Reims, France.
| | - Olivier Mares
- Service de chirurgie orthopédique et traumatologique, CHU Carémeau, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France
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Liu K, Mu L, Liu J, Fu Z, Chen L, Liu B. Distal radius fracture malunion in an adolescent patient treated with osteotomy and autologous iliac bone grafting: A case report. Medicine (Baltimore) 2020; 99:e22535. [PMID: 33019460 PMCID: PMC7535638 DOI: 10.1097/md.0000000000022535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Adolescent wrist trauma can cause epiphyseal dysplasia and even distal radius deformity malunion. At present, there is no uniform treatment standard for the malunion of the distal radius of adolescents. Osteotomy and autologous bone grafting are currently one of the effective ways to treat the disease. We treated an adolescent patient with distal radius deformity malunion, and used this surgical method to treat the patient and achieved satisfactory results. PATIENT CONCERNS A 16-year-old boy suffered from a serious distal radius deformity after trauma of the left wrist 8 years ago. DIAGNOSES Physical examination, X-rays examination, high-resolution computed tomography scan, and 3-dimensional reconstruction images of the affected limb helped us diagnose the distal radius fracture malunion. INTERVENTIONS The fracture malunion was treated by osteotomy and autologous iliac bone grafting. OUTCOMES At the 2-year follow-up, wrist flexion returned to 68°, wrist dorsiflexion to 55°, radial deviation to 14°, ulnar deviation to 12°, forearm pronation to 75°, supination to 67°. Grip strength increased to 35.1 kg after 2 years of operation, recovered to 87% of the uninjured side. Quick DASH score at 2-year follow-up was 9. No complication, such as nonunion or infection, was observed. LESSONS This rare case provides valuable insights for hand surgeons. High-resolution computed tomography scan and 3-dimensional reconstruction can help us effectively diagnose wrist diseases. Small lesions on the articular surface of the distal radius will change the position and function of the wrist joint, and cause traumatic arthritis of the wrist joint. Therefore, it is very important to reconstruct the normal structure of the distal radius articular surface. Osteotomy and autologous iliac bone grafting are effective treatments for serious distal radius fracture malunion in the adolescent patient. During the operation, care should be taken to protect the osteoepiphysis to avoid bone dysplasia.
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Affiliation(s)
- Kai Liu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University
- Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun
| | - Lin Mu
- Department of Radiology, The First Hospital of Jilin University, Jilin, China
| | - Jianfeng Liu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University
- Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun
| | - Zhuo Fu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University
- Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun
| | - Lei Chen
- Department of Hand and Foot Surgery, The First Hospital of Jilin University
- Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun
| | - Bin Liu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University
- Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, Changchun
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Katt B, Seigerman D, Lutsky K, Beredjiklian P. Distal Radius Malunion. J Hand Surg Am 2020; 45:433-442. [PMID: 32220492 DOI: 10.1016/j.jhsa.2020.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 02/02/2023]
Abstract
Malunion remains the most common complication of nonsurgical treatment of fractures of the distal radius and represents a common clinical entity. Symptomatic treatment often involves corrective osteotomy. Surgical correction is a challenging problem with unpredictable clinical outcomes. Prevention of malunion of a distal radius fracture is the best course of action. With maintenance of volar cortical contact and the use of volar fixed-angle devices, bone grafting may not be necessary in certain cases of malunion correction. New technologies such as 3-dimensional modeling and computer-generated osteotomy guides are likely to have a positive impact on the outcomes of surgical treatment.
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Affiliation(s)
- Brian Katt
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, PA.
| | - Daniel Seigerman
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, PA
| | - Kevin Lutsky
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, PA
| | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, PA
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