ADAPTIVE REALIGNMENT OF THE WRIST IN CASES OF MALUNITED FRACTURES OF THE DISTAL RADIUS

Abstract

Wrist malalignment, in cases of malunited fractures of the distal radius, is not always a consequence of adaptation of the wrist to new conditions, but an expression of non-diagnosed ligamentous injuries. The aim of our study is to examine if the wrist malalignment is correctable with radius osteotomy.

Twenty nine patients (17 female, 12 male) of mean age 51 years, with symptomatic malunited fracture of the distal radius with dorsal angulation, of duration 3 months -47 years, were examined. Twenty seven patients underwent corrective radius osteotomy (open dorsally in 26 cases and closed palmarly in 1 case). Fixation material (plate and screws) was placed on the dorsal side in 23 cases and on the volar side in 4 cases. In all patients measurements on the lateral X-ray view, concerning the reversal of the normal palmar tilt of the radius, the radiolunate and lunocapitate angles, were performed before and after surgery. Based on those measurements patients were divided in two groups:

1. a) In group A (23 patients) the malalignment concerned the midcarpal joint, and

2. b) In group B (6 patients) the malalignment concerned the radiocarpal joint.

The radiographic element of evaluation was the radiolunate angle. Radiolunate angle greater than 25° indicated malalignment at the radiocarpal level while radiolunate angle less than 25° indicated malalignment at the mid-carpal level. In 5 patients post-operative measurements were not performed because in addition to the radial osteotomy they were subjected to operative correction of wrist malalignment.

Results estimated immediately postoperative and at the final follow-up, 6 months later. In patients with midcarpal malalignment, correction was possible, under the condition of a sufficient radius osteotomy and a non fixed midcarpal deformity. In patients with radiocarpal malalignment the deformity persisted despite the correction of the radial osteotomy.

We conclude that correction of wrist malalignment is not always achieved with corrective osteotomy of the radius and that preoperative radiological control may be indicative of the possibility of correcting the deformity.