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Meesters AML, Assink N, IJpma FFA. Functional outcome of 2-D- and 3-D-guided corrective forearm osteotomies: a systematic review. J Hand Surg Eur Vol 2024; 49:843-851. [PMID: 37747738 PMCID: PMC11264531 DOI: 10.1177/17531934231201962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/26/2023]
Abstract
We performed a systematic review to compare conventional (2-D) versus 3-D-guided corrective osteotomies regarding intraoperative results, patient-reported outcome measures, range of motion, incidence of complications and pain score. PubMed (MEDLINE), Embase and Cochrane CENTRAL were searched, and 53 articles were included, reporting 1257 patients undergoing forearm corrective osteotomies between 2010 and 2022. 3-D-guided surgery resulted in a greater improvement in median Disabilities of the Arm, Shoulder and Hand (DASH) score (28, SD 7 vs. 35, SD 5) and fewer complications (12% vs. 6%). Pain scores and range of motion were similar between 3-D-guided and conventional surgery. 3-D-guided corrective osteotomy surgery appears to improve patient-reported outcomes and reduce complications compared to conventional methods. However, due to the limited number of comparative studies and the heterogeneity of the studies, a large randomized controlled trial is needed to draw definitive conclusions.Level of evidence: III.
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Affiliation(s)
- Anne M. L. Meesters
- Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- 3D Lab, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Nick Assink
- Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- 3D Lab, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank F. A. IJpma
- Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Haines SC, Bott A. Current Concepts: Corrective Osteotomy for Extra-Articular Deformity Following a Distal Radius Fracture. Cureus 2023; 15:e47019. [PMID: 37965406 PMCID: PMC10642188 DOI: 10.7759/cureus.47019] [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: 10/14/2023] [Indexed: 11/16/2023] Open
Abstract
Fracture malunion alters wrist and distal radioulnar joint (DRUJ) biomechanics, resulting in incongruence and instability of the DRUJ. Selected patients with painful functional limitation and significant deformity of the radius, but without advanced degenerative joint disease, may benefit from corrective distal radial osteotomy. Non-union and complications arising from metalwork are the most common reasons for reoperation. Surgeons should have a good understanding of risks and complications in order to fully inform their patients and manage expectations. This article reviews the biomechanical effects of radial malunion and the current concepts for treatment. Distal radial osteotomy is suitable for symptomatic patients with angular radial deformity and shortening. Evidence supports a volar approach without bone grafts for modest corrections. Bone grafts or synthetic bone substitutes are appropriate for larger corrections. Functional improvements are reported regardless of technique. Despite a high complication rate, patient satisfaction with the corrective radial osteotomy is high.
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Affiliation(s)
- Samuel C Haines
- Trauma and Orthopaedics, Bristol Royal Infirmary, Bristol, GBR
| | - Alasdair Bott
- Trauma and Orthopaedics, Southmead Hospital, Bristol, GBR
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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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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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Corrective Osteotomy of Distal Radius Malunion Using a Rectangular-shaped Iliac Bone Graft and Volar Plating. Tech Hand Up Extrem Surg 2020; 25:130-135. [PMID: 33122494 DOI: 10.1097/bth.0000000000000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Distal radius fractures are one of the most common injuries seen by orthopedists at the emergency room and clinics. Severity and configuration may vary, and therapeutic options are broad, but regardless of the course of treatment, all cases can potentially lead to malunion. When malunion requires surgical correction, the surgery can be technically demanding. Here, we demonstrate an alternative technique to perform corrective osteotomies for extra-articular or minimally displaced articular distal radius malunion. We provide simplification of the procedure by eliminating one of the planes taken into consideration when performing an osteotomy. This technique includes the use of a tricortical iliac bone graft, which we feel, provides dependable structural support, preventing collapse. The technique allows the surgeon an easy means to access the osteotomy gap and apply the graft. Finally, we supplement this surgical technique by providing our outcomes. Our data suggest that the technique effectively restores radiographic wrist parameters and provides good union rates.
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Yaradılmış YU, Tecirli A, Örs Ç. Distal radius correction osteotomy with tricortical bone graft is a successful method in heavy smokers. J Orthop 2020; 18:150-154. [PMID: 32021022 DOI: 10.1016/j.jor.2019.09.006] [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: 07/14/2019] [Accepted: 09/11/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Corrective osteotomy is a technically challenging surgical option to improve wrist function in tilted distal radius malunions. However fracture healing in smokers is adversely affected. The aim of this study was to evaluate the clinical and radiological effect of cigarettes on bone union in heavy-smokers who underwent corrective osteotomy with a triangular bone graft harvested from the iliac crest. METHOD Fifteen patients, who were treated using trapezoidal block grafts taken from the iliac crest, who were smokers of 20 or more cigarettes daily (heavy smokers) with no chronic disease, and who consented to participate in the study. Fifteen non-smoker patients of the same age group were determined as the control group. Radiological measurements were made to include radial inclination and ulnar variance in pre-operative and post-operative radiographs. Functional evaluation was performed using Q-DASH and MAYO hand-wrist scores. RESULTS In both groups, the mean age of the patients was 49,1 ± 3,92 years. Smokers group the bone union in the osteotomy line was observed after 16,63 (12-24 h) weeks, non-smokers grup 14.1 (12-24) weeks (p = 0.06). Range of motion is found similar clinic between in groups (p > 0.05). Q-DASH for group smokers was 17.54 ± 1.85, nonsmokers 17.20 ± 1.24 (p = 0,878); MAYO was 82.27 ± 6.06 for 82.00 ± 7.74 (p = 0.874). for group B. No statistically significant difference was noted between the groups. CONCLUSION Our study showed that cigarette smoking did not have negative effect on union time in the metaphyseal region after correction osteotomy. The time of bone-union in heavy-smokers was 2.5 weeks more than that of non-smokers.
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Affiliation(s)
| | - Ali Tecirli
- Orthopedics and Traumatology Clinic Çankırı State Hospital, Çankırı, Turkey
| | - Çağrı Örs
- Orthopedics and Traumatology Clinic, Orthopedica Private Hospital, Adana, Turkey
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Xu J, Zhang G, He Z, Zhong S, Chen Y, Wei C, Zheng Y, Lin H, Li W, Huang W. Anatomical reduction and precise internal fixation of intra-articular fractures of the distal radius with virtual X-ray and 3D printing. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 43:10.1007/s13246-019-00795-w. [PMID: 31641940 PMCID: PMC7026237 DOI: 10.1007/s13246-019-00795-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/10/2019] [Accepted: 08/29/2019] [Indexed: 12/29/2022]
Abstract
To evaluate and precisely internal fix intra-articular distal radial fracture (IDRF) using the virtual X-ray and three-dimensional (3D) printing technologies. Twenty-one patients with IDRF were recruited, and the data from digital design group (DDG) and real surgery group (RSG) were collected and analyzed. In DDG, the data from thin-slice computed tomography scan, virtual X-ray measurement parameters, including volar tilt, palmar tilt, radius length (D1), ulnar variation (D2), locking plate position parameter (D3) and distance between key nail and joint surface (D4) were collected. The bone was virtually fixed with the locking plate, and the final model of radius with the screw was obtained by 3D printing. In RSG, the locking plate was precisely pre-bended and used in surgery. During the surgery, the key K-wire was accurately placed and the locking plate was adjusted with the aid of the U-shaped navigation arm. The C-arm was used to observe the positions of key K-wires and the locking plate, and the same above-mentioned parameters were measured intra- and post-operatively. The data from RSG and DDG were compared statistically by t test. This approach proved to be successful in all 21 patients, and none of the screws pierced through the wrist joint surface. All the measured parameters, including the volar tilt, palmar tilt, D1-4, in RSG were not significantly different from preoperative DDG data. Virtual X-ray measurement of anatomical reduction parameters and 3D printing can help the anatomical reduction and precise internal fixation by providing quantitative references, preoperatively, intraoperatively and postoperatively.
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Affiliation(s)
- Jing Xu
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, No. 1838 Guangzhou Road North, Guangzhou, 510515 Guangdong China
| | - Guodong Zhang
- Department of Orthopedics, Affiliated Hospital of Putian University, No. 999 East Shenzhen Road, Licheng District, Putian City, 510080 Fujian China
| | - Zaopeng He
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Shizhen Zhong
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, No. 1838 Guangzhou Road North, Guangzhou, 510515 Guangdong China
| | - Yongshao Chen
- Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Chunrong Wei
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Yudong Zheng
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Haibin Lin
- Department of Orthopedics, Affiliated Hospital of Putian University, No. 999 East Shenzhen Road, Licheng District, Putian City, 510080 Fujian China
| | - Wei Li
- Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, No. A163, Middle Road, Lecong Avenue, Shunde District, Foshan, 528315 Guangdong China
| | - Wenhua Huang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, No. 1838 Guangzhou Road North, Guangzhou, 510515 Guangdong China
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Extra-articular Corrective Osteotomy With Bone Grafting to Achieve Lengthening and Regain Alignment for Distal Radius Fracture Malunion. Tech Hand Up Extrem Surg 2019; 23:186-190. [PMID: 31157736 DOI: 10.1097/bth.0000000000000252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Surgical correction of the distal radius fracture malunion is challenging because of the 3-dimensional deformity. We propose a method by using the Kapandji intrafocal pinning in corrective osteotomy for treatment of the distal radius fracture malunion to facilitate the alignment correction while using the bone graft to restore the radial length. The surgery was started with the osteotomy from a volar approach, and the osteotomy gap was expanded gradually. Then, allobone grafting was performed to maintain the corrected radial length. We used the Kapandji intrafocal pinning dorsally to provide dorsal supporting force and radially to correct the radial inclination. Finally, a volar plate was used to buttress and push the distal fragment to fit as to regain the correct volar tilt. We enrolled 10 patients of distal radius fracture malunion with a mean age of 59.3 years. All patients had bone healing within 3 months after surgery. The mean lengthened distance was 5 mm. The radial inclination and volar tilt could be corrected with improved functional results.
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Chen ACY, Cheng CY, Weng CJ, Chou YC. Intramedullary nailing and plating osteosynthesis in the correction of post-traumatic deformity in late-diagnosed distal radius fractures: a retrospective comparison study. BMC Musculoskelet Disord 2019; 20:236. [PMID: 31113405 PMCID: PMC6530186 DOI: 10.1186/s12891-019-2605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 04/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background Various surgical modalities are available for correction of deformity in late-diagnosed distal radius fractures. This study compared surgical outcomes between intramedullary nailing and plating osteosynthesis in open-wedge osteotomy. Methods We retrospectively reviewed 47 unilateral distal radius fractures that underwent open-wedge osteotomy at more than 4 weeks after injury between 2006 and 2011. A locally resected exuberant callus was used as the bone graft. Two types of fixation were used: intramedullary nail in 22 patients (group A) and locking plate in 25 patients (group B). Radiographic analysis including radial height, radial inclination, and volar tilt were performed preoperatively and 2-year postoperatively. The Modified Mayo Wrist Score (MMWS) was used for functional evaluation and a 10-point visual analog scale (VAS) for residual pain assessment. Patient satisfaction was self-reported as a 5-point scale. Radiographic data, functional outcomes, and surgical complications were compared between the two groups. Results All fractures achieved bone union without major complications. The MMWS averaged 84.8 ± 9.7 in group A and 85.2 ± 8.4 in group B, without significant differences (p = 0.436). Instead, significant differences were found in mean wrist flexion (73.6 ± 7.9 vs. 69.6 ± 7.8 degrees; p = 0.042), patient satisfaction (3.6 ± 1.1 vs. 2.9 ± 1.2; p = 0.034), postoperative radial height (11.6 ± 2.6 vs. 10.2 ± 3 mm; p = 0.039) and inclination (20.8 ± 2.8 vs. 17.7 ± 4.1 degrees; p = 0.004), and implant-related complications (9% vs. 36%; p = 0.03). There were no significant differences in other assessment items including postoperative grip strength, pain scale, supination/pronation/extension, volar tilt, correction angles of all three parameters, and general complication rate. Four patients in group A (18%) and 2 in group B (8%) experienced postoperative paresthesia of the surgical hand; no significant difference was noted. All except one patient in group B had full recovery of neurological symptoms. Conclusions Open-wedge osteotomy with either an intramedullary nail or locking plate fixation yielded encouraging radiographic and functional outcomes. Intramedullary nail fixation may facilitate restoration of radial height and inclination with better wrist flexion, less implant-related complications, and greater patient satisfaction.
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Affiliation(s)
- Alvin Chao-Yu Chen
- Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China. .,Chang Gung University College of Medicine, Taoyuan City, Taiwan.
| | - Chun-Ying Cheng
- Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chun-Jui Weng
- Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Ying-Chao Chou
- Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
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Bytyqi C, Qorraj H, Tolaj A, Hajdari R. Corrective osteotomy of distal radius malunion after IIIB open fracture: Palmar approach - Case report. Int J Surg Case Rep 2019; 58:193-197. [PMID: 31075701 PMCID: PMC6510939 DOI: 10.1016/j.ijscr.2019.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/27/2019] [Accepted: 04/08/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite the fact that distal radius fractures are the most common, open fractures are relatively uncommon. The aim of this study is to present the case with severe malunion of extra-articular left distal radius after open fracture grade IIIB (Gustillo). The treatment was done with open correctuve osteotomy and ostosynthesis with volar low profile plate. CASE PRESENTATION A 32-years old man was admitted to our departement because of severely malunited left distal radius extra-articular metaphyseal fracture after treatment of an open fracture. He was primary treated in a Regional Hospital with irrigation, debridement, antimicrobial cover, and immediate skeletal management through fixation with Kirschner's wires. No external fixator was used. He developed volar metaphyseal angulation after loss of primary reduction of K-wires fixation; therefore it required corrective surgical treatment. Because of malunion, open corrective osteotomy and bone grafting of distal radius with volar plating were done. Follow-up 20 months after surgery show deformity correction of radial volar inclination, height, and restitution of distal radioulnar joint. CONCLUSION This case report offers an informative overview on this uncommon case of distal radius open fracture malunion treated successfully with volar approach corrective osteotomy. Corrective surgery is the primary therapy of choice in the this case. This method have shown to be safe and effective in treatment of distal radius malunion with volar angulation.
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Affiliation(s)
- Cen Bytyqi
- Medical Faculty, University of Prishtina "Hasan Prishtina", Kosovo; University Clinical Center of Kosovo, Orthopedic Department, Kosovo.
| | - Hasime Qorraj
- Medical Faculty, University of Prishtina "Hasan Prishtina", Kosovo.
| | - Arber Tolaj
- University Clinical Center of Kosovo, Orthopedic Department, Kosovo.
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Winge MI, Røkkum M. CaP cement is equivalent to iliac bone graft in filling of large metaphyseal defects: 2 year prospective randomised study on distal radius osteotomies. Injury 2018; 49:636-643. [PMID: 29361294 DOI: 10.1016/j.injury.2017.11.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 11/10/2017] [Accepted: 11/20/2017] [Indexed: 02/02/2023]
Abstract
The purpose of this prospective randomised study was to compare the clinical and radiological outcomes of injectable CaP bone cement with corticocancellous bone graft used to fill voids after corrective opening wedge osteotomies in the distal radius. 17 women/3 men, median age 56 (51.3; 61.0), underwent an open-wedge osteotomy of a dorsal malunion in the distal radius randomised to filling the defect either with bone graft (10) or CaP bone cement (10). Dorsal titanium locking plates were used and the wrist was plastered for 8 weeks. Follow-ups for 24 months included X-rays, CT scans, VAS on wrist and iliac crest, grip strength, ROM, Quick-DASH and Gartland & Werley scores. No difference was found between the 2 groups as to clinical outcome or radiological results with no loss of reduction. One bone graft patient developed a pseudarthrosis and one CaP patient suffered a plate fracture 6 months post-operatively. CaP bone cement is a good alternative to bone graft as a void filler in open-wedge osteotomies of the distal radius. The procedure is shorter, easier with the post-operative advantage of no donor site pain. Level of Evidence Randomised controlled trial. Level I evidence.
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Affiliation(s)
- Mona I Winge
- Division of Orthopaedic Surgery, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Magne Røkkum
- Division of Orthopaedic Surgery, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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12
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Mulders MAM, d'Ailly PN, Cleffken BI, Schep NWL. Corrective osteotomy is an effective method of treating distal radius malunions with good long-term functional results. Injury 2017; 48:731-737. [PMID: 28179058 DOI: 10.1016/j.injury.2017.01.045] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/27/2017] [Accepted: 01/29/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Malunion occurs in approximately 23% of non-operatively treated and 11% of operatively treated distal radius fractures. The decision whether to correct a malunion is primarily based on functional impairment and wrist pain. The purpose of this study was to assess the long-term functional outcomes of corrective osteotomies for symptomatic malunited distal radius fractures. METHODS All consecutive corrective osteotomies of the distal radius performed in one centre between January 2009 and January 2016 were included. The primary outcome was the functional outcome assessed with the Disability of the Arm, Shoulder and Hand (DASH) and the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcomes were range of motion, grip strength, pain as indicated on the Visual Analogue Scale (VAS) before and after corrective osteotomy, radiological parameters, time to union and complications. Additionally, we aimed to determine if there were any difference in graft versus no graft usage. RESULTS A total of 48 patients were included. The median age was 54.5 years (IQR 39-66) and 71% was female. The median time to follow-up was 27 months. The median DASH and PRWE score were respectively 10.0 (IQR 5.8-23.3) and 18.5. (6.5-37.0). Except for pronation and supination, range of motion and grip strength of the injured wrist were significantly less compared to the uninjured side. Palmar and dorsal flexion and radial and ulnar deviation of the injured wrist were significantly less compared with the uninjured side. VAS pain scores decreased significantly from 6.5 preoperative to 1.0 postoperative. The median time to union was 23 weeks (IQR 12-29.5). Eighteen patients (38%) had a complication for which additional treatment was required. Except for a significant difference in radial inclination and length after the corrective osteotomy in favour of graft usage, there were no significant differences between graft an no graft usage. CONCLUSIONS Corrective osteotomy is an effective method of treating symptomatic distal radius malunions with good long-term functional results, measured with the DASH and PRWE score, and improvement in radiographic parameters and pain scores. Additionally, no differences in functional outcomes were found between graft and no graft usage.
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Affiliation(s)
- M A M Mulders
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - P N d'Ailly
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - B I Cleffken
- Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC Rotterdam, The Netherlands
| | - N W L Schep
- Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC Rotterdam, The Netherlands
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Traitements des cals vicieux extra-articulaires de l’extrémité distale du radius du sujet jeune actif. HAND SURGERY & REHABILITATION 2016; 35S:S99-S104. [DOI: 10.1016/j.hansur.2016.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/10/2015] [Accepted: 02/17/2016] [Indexed: 11/18/2022]
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Mugnai R, Tarallo L, Lancellotti E, Zambianchi F, Di Giovine E, Catani F, Adani R. Corrective osteotomies of the radius: Grafting or not? World J Orthop 2016; 7:128-135. [PMID: 26925385 PMCID: PMC4757658 DOI: 10.5312/wjo.v7.i2.128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 10/03/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the current literature regarding corrective osteotomies to provide the best evidence of the rule of bone grafting.
METHODS: Our MEDLINE literature search included 280 studies using the following key words “Malunited distal radius fracture” and 150 studies using key words “Corrective osteotomy of the distal radius”. Inclusion criteria were: Malunited distal radial, extra articular fracture, volar locking plate, use of iliac bone graft (cancellous or corticocancellous), non-use of bone graft. Twelve studies met the inclusion criteria.
RESULTS: Seven of the 12 studies considered, described the use of a graft; the remaining five studies didn’t use any graft. Type of malunion was dorsal in most of the studies. The healing time was comparable using the graft or not (mean 12.5 wk), ranging from 7.5 to 16 wk. The mean disabilities of the arm, shoulder and hand score improvement was 23 points both in the studies that used the graft and in those not using the graft.
CONCLUSION: This review demonstrated that corrective osteotomy of extra-articular malunited fractures of the distal radius treated by volar locking plate does not necessarily require bone graft.
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Taleb C, Zemirline A, Lebailly F, Bodin F, Facca S, Gouzou S, Liverneaux P. Minimally invasive osteotomy for distal radius malunion: A preliminary series of 9 cases. Orthop Traumatol Surg Res 2015; 101:861-5. [PMID: 26454409 DOI: 10.1016/j.otsr.2015.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 06/05/2015] [Accepted: 07/24/2015] [Indexed: 02/02/2023]
Abstract
UNLABELLED The rate of malunion after distal radius fractures is 25% after conservative treatment and 10% after surgery. Their main functional repercussion related to ulno-carpal conflict is loss of wrist motion. We report a retrospective clinical series of minimally invasive osteotomies. The series consisted of 9 cases of minimally invasive osteotomies with volar locking plate fixation. All osteotomies healed. The average pain was 5.3/10 preoperatively and 2.1/10 at last follow-up. The mean Quick DASH was 55.4/100 preoperatively and 24.24/100 at last follow-up. Compared to the opposite side, the average wrist flexion was 84.11%, the average wrist extension was 80.24%, the average pronation was 95.33% and the average supination was 93.9%. With similar results to those of the literature, our short series confirms the feasibility of minimally invasive osteotomy of the distal radius for extra-articular malunion. TYPE: Case-series. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- C Taleb
- Hand Surgery Department, Strasbourg University Hospitals, FMTS, University of Strasbourg, Icube CNRS 7357, 67403 Illkirch, France
| | - A Zemirline
- Hand Surgery Department, Private Hospital Saint-Grégoire, 35760 Rennes, France
| | - F Lebailly
- Hand Surgery Department, Saint-Paul Institute, 97200 Fort-de-France, Martinique
| | - F Bodin
- Plastic Surgery Department, Strasbourg University Hospitals, FMTS, University of Strasbourg, 67000 Strasbourg, France
| | - S Facca
- Hand Surgery Department, Strasbourg University Hospitals, FMTS, University of Strasbourg, Icube CNRS 7357, 67403 Illkirch, France
| | - S Gouzou
- Hand Surgery Department, Strasbourg University Hospitals, FMTS, University of Strasbourg, Icube CNRS 7357, 67403 Illkirch, France
| | - P Liverneaux
- Hand Surgery Department, Strasbourg University Hospitals, FMTS, University of Strasbourg, Icube CNRS 7357, 67403 Illkirch, France.
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Chen CH, Zhou RK, Zhen HQ, Huang L, Jiao YJ. Efficacy of volar and dorsal plate fixation for unstable dorsal distal radius fractures. Int J Clin Exp Med 2015; 8:4375-4380. [PMID: 26064356 PMCID: PMC4443190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 01/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To compare the efficacy of volar and dorsal plate fixation for unstable dorsal distal radius fractures. METHODS Forty-seven cases were selected from patients undergoing surgical reduction and internal fixation treatment in our hospital from August 2006 to October 2010, with 21 males and 26 females, aged 39-73 years old. Patients were divided into two groups: volar plate fixation group (Group A) which has 32 cases, including 27 cases with locking plate, 5 cases with ordinary T plate, and 4 cases combined with dorsal Kirschner wire fixation; dorsal plate fixation group (Group B) which has 15 cases, including 7 cases with locking plate. The efficacy of the two fixation methods were compared in terms of postoperative wrist function, X-ray score, and postoperative complications. RESULTS Compared with those of preoperative groups, the volar tilt, ulnar deviation and radial styloid height in both group A and B were significantly improved one week after surgery as shown by X-ray imaging. Comparison of X-ray images one week after surgery with those of six months after surgery showed no significant changes in volar tilt, ulnar deviation or radial styloid height. 87.5% of patients in group A and 86.7% of patients in group B got "excellent" in their wrist function assessment, and there was no significant difference between the two groups (X(2)=0.825, P=1.000). But patients in group A hax significantly lower incidence rate of postoperative complications than group B (X(2)=4.150, P=0.042). CONCLUSION For unstable distal radius fractures with dorsal displacement, volar plate fixation can achieve satisfactory reduction results, and cause less tendon damage or other complications than dorsal plate fixation.
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Affiliation(s)
- Chang-Hong Chen
- Department of Orthopaedics, Jiangyin Traditional Chinese Medical Hospital Jiangyin, Jiangsu, China
| | - Rong-Kui Zhou
- Department of Orthopaedics, Jiangyin Traditional Chinese Medical Hospital Jiangyin, Jiangsu, China
| | - Hua-Qing Zhen
- Department of Orthopaedics, Jiangyin Traditional Chinese Medical Hospital Jiangyin, Jiangsu, China
| | - Lei Huang
- Department of Orthopaedics, Jiangyin Traditional Chinese Medical Hospital Jiangyin, Jiangsu, China
| | - Ya-Jun Jiao
- Department of Orthopaedics, Jiangyin Traditional Chinese Medical Hospital Jiangyin, Jiangsu, China
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