Abstract
We retrospectively reviewed thirty-six patients who had undergone dorsal opening wedge osteotomies using cancellous bone graft and plate fixation for symptomatic healed angulated distal radius fractures.
Average improvement of the distal radius dorsal articular tilt was 28° and the ulna variance 2.7mm. The final average range of motion was flexion 46°, extension 62°, pronation 79°and supination 75°. The range of supination and pronation was not significantly different from the unaffected limb (p> 0.115).
For healed angulated distal radius fractures, dorsal opening wedge osteotomy combined with cancellous bone grafting and plate fixation, is a reliable technique allowing significant deformity correction.
We retrospectively reviewed thirty-six patients with symptomatic healed angulated distal radius fractures who had undergone dorsal opening wedge osteotomies using cancellous bone graft and plate fixation by a single surgeon. Twenty-five patients were reviewed both clinically and radiologically with an average follow-up of forty-seven months. The radiographs of a further eleven patients were reviewed.
Average age at surgery was fifty years with an interval from injury of twenty-nine months. All osteotomies united. 20% required plate removal.
Preoperatively the average distal radius articular tilt was 25° dorsal, and ulna variance +4.3mm. Following correction, average articular tilt was 3° volar, and ulna variance +2mm. These changes were highly significant (p< 0.0005). There was no significant loss of correction of the deformity between the immediate postoperative radiographs and those following union (p> 0.33).
The average range of motion was flexion 46°, extension 62°, pronation 79°and supination 75°. The range of pronation and supination was not significantly different from the unaffected limb (p> 0.115).
The average Patient Rated Wrist Evaluation Score was thirty, indicating residual pain and disability greater than that for an age matched cohort of patients with uncomplicated distal radius fractures (PRWE=15), previously reported by our laboratory. Patients reported that they were satisfied with the cosmetic appearance and had regained 73% of wrist use – these values had a significant negative correlation with the final ulna variance (p< 0.05).
For healed angulated distal radius fractures, dorsal opening wedge osteotomy combined with cancellous bone grafting and plate fixation, is a reliable technique allowing significant deformity correction.
Correspondence should be addressed to Cynthia Vezina, Communications Manager, COA, 4150-360 Ste. Catherine St. West, Westmount, QC H3Z 2Y5, Canada
