Corrective Radial and Ulnar Osteotomies for Distal Radial Fracture Malunion.

Abstract

We describe a technique consisting of simultaneous radial closing-wedge and ulnar shortening osteotomy to treat malunion of distal radial fractures. Plan the radial closing-wedge osteotomy to correct the volar tilt angle to 8.5° to 15.5° and the ulnar shortening osteotomy to restore ulnar variance to -2.5 to 0.5 mm. Remove the wedge of bone from the radius and reduce the distal fragment, keeping the dorsal cortex as a hinge. Resect the section of the ulna equivalent to the positive ulnar variance with transverse osteotomies. Hold together the two fragments of the radius with a Kirschner wire and fix the osteotomy site with a volar locking plate. Evaluate residual ulnar positive variance with fluoroscopy and restore the ulnar variance to within a normal range by removing additional bone from the proximal fragment. Use a compression device to close and fix the ulnar osteotomy site. Allow early motion immediately after the operation. We retrospectively evaluated forty-two patients at a minimum of one year after treatment of an extra-articular distal radial malunion with a radial corrective osteotomy. IndicationsContraindicationsPitfalls & Challenges.