Abstract
Introduction and Aims: Rotational malalignment following fracture of the distal radius results in subluxation of the distal radioulnar joint, alteration of the normal contact area of the ulnar head in the sigmoid notch of the radius, arthrosis, pain, limited pronation and supination and dysfunction. This paper describes the technique for restoration of appropriate rotation, as well as length and angulation following malunion.
Method: Eleven cases of derotational osteotomy of the distal radius with low-profile plate fixation have been performed for correction of rotational malalignment with restoration of appropriate articular tilt, length and alignment. In eight cases, the articular surface of the distal ulna was found to be too degenerated to salvage the distal radioulnar joint and resection of the distal ulna with soft tissue reconstruction was performed.
Results: Healing of the osteotomy of the distal radius was achieved in all 11 patients. None of the patients undergoing distal resection demonstrated instability of the distal radioulnar joint but one demonstrated distal radioulnar impingement. One patient with a preserved ulnar head demonstrated ulnocarpal abutment and required late secondary ulna head resection. Pre-operative pronation/supination arc was 40 degrees and postoperative arc was 130 degrees. In eight of the 11, pain was rated as zero on a 10-point scale, while the other three ranged between two and five on the same scale. At a two-year follow-up, grip strength measured 80% of the contralateral side while total range of motion measured 76% of the contralateral side. All 11 patients were functional at daily household activities, five out of seven previously working patients were back to work, and all patients felt that their post-operative status was a significant improvement over their pre-operative status.
Conclusion: Rotatory malpositioning following distal radius fracture provides significant disability. Derotational osteotomy can be effective in restoring pronation and supination, diminishing pain and increasing function. Late treatment may also require resection of the distal ulnar articular surface due to post-traumatic arthrosis. Soft tissue stabilisation at the time of osteotomy provides stability of the distal radioulnar joint in the majority of cases.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
None of the authors is receiving any financial benefit or support from any source.
