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General Orthopaedics

OUTCOMES OF CORRECTIVE OSTEOTOMY AND VOLAR LOCKING PLATE FOR MULTI-PLANAR MAL-UNITED DISTAL RADIUS FRACTURES

British Limb Reconstruction Society (BLRS) AGM & Instructional Course



Abstract

Objective

The aim of this retrospective study is to assess the functional and radiological outcome of a multi-planar corrective osteotomy, distraction and locking fixed angle volar plate as the standard of treatment of distal radius mal-unions that require multi-planar correction.

Methods

We conducted a retrospective study on 13 consecutive patients – 4 males, 9 females (mean age 49). All patients underwent volar approach, open wedge distraction osteotomy locking fixed angle volar plate and cancellous bone grafting Radiographic measurements and functional assessments were taken preoperatively, 3, 6 months and one year.

Results

Time to surgery from the original fracture had a mean of 17.4 months (range 8–36 months). Mean follow-up was 16.4 months (range from 6 to 45 months). Osteotomy healing time was 11.3 weeks on average. All radiographic measurements improved postoperatively, ten patients had an average of 18.84 degrees of dorsal tilt which was corrected to a volar tilt of 9.17 degrees on average. Ulna variance was initially positive in all patients with an average of 2.6 mm which was corrected to less than one (0.96 mm); three patients had radial angulations of 20.6 degrees on average, which were fully corrected postoperatively. Flexion-extension arc has improved with significant difference and so has the grip and pinch strength. The average DASH and SF12 scores has shown figures comparative to the normal population post deformity correction

Complications included one case of low grade wound infection and one case of postoperative symptoms of carpal tunnel syndrome.

Conclusion

The described technique is a useful means to correct distal radius anatomy and function; however patients should be aware that it is not always possible to regain full function and anatomy.