DISTAL RADIUS MALUNION. CORRECTIVE OSTEOTOMY FOR CARPAL ALIGNMENT IMPROVEMENT

Abstract

Objective: Deformity post distal radius fracture can be associated with alterations in carpal kinematics. This study presents a review to detect the prevalence and clinical implications of such deformities and the variables that influence the outcome following osteotomy.

Material & Methods: 29 patients with distal radius mal-union, and an average age of 43 yrs, were treated by a single surgeon with a corrective osteotomy. Along with pain scales, wrist motion, and grip strength, pre and post osteotomy radiographs were evaluated. Preoperatively, 18 patients had dorsal deformity, 9 volar and 2 shortening and malrotation alone. 20 patients had carpal malalignment and 9 normal carpal alignment.

Results: The average follow up was 21 months. 24 out of 29 radial deformities were corrected to normal. Overall 17 patients had post-op normal carpal alignment. Three groups resulted; Group I: 11 patients with pre and post-op “fixed” deformities. Group II: 8 patients with normal pre and post-op carpal alignment; and Group III: 9 patients with “lax” pre-op malalignment converted to normal post-op. 1 patient was normal pre-op and converted to DISI at post-op. There was no statistically difference in outcome with regard to pain, forearm rotation, wrist extension, patient age or time to surgery between the three groups. There was statistically significant greater wrist flexion in Group II and III compared to Group I.

Conclusions: Carpal malalignement post radius osteotomy will have a negative effect on the functional outcome compared to those patients with preoperative carpal deformity, which corrects with radius osteotomy. Knowledge of this association will help advice patients of expected outcomes.