Correcting a malunited distal radial fracture usually requires osteosynthetic material applied on the dorsal side of the radius. However, contact of the material with the extensor tendons often produces irritation and rupture problems. The aim of this study is to evaluate the effectiveness of the specific osteosynthetic material (Trimed) in treating malunion of intra- or extra-articular fractures of the distal radius, after a corrective osteotomy.

We examined 11 patients (7 females, 4 males), with average age of 42 years (ranging from 21 to 69 years old), 10 of which presented with symptomatic malunited distal radial fracture of a mean duration of 2.85 months (2–7 months). In one patient the malunited fracture was 30 years old. In 7 patients the malunited fracture was extra articular whereas in 4 patients it was intra articular. A corrective osteotomy was performed in all cases, followed by application of the special osteo-synthetic material by Trimed on the dorsal side of the radius. In seven patients iliac crest bone graft was used, whereas in four allografts were applied. Furthermore, five patients had to undergo additional surgical procedures. More specifically, shortening osteotomy of the ulna in 3 patients, radio-scapho-lunate fusion in 1 and excision of scaphoid with carpal tenodesis in 1 patient.

After a mean follow-up of 15 months (6–27 months) the results were evaluated based on (Fernadez 2001), pain, range of motion, and grip strength. Excellent results (18–20 points) were observed in three patients, good results (15–17 points) in five patients and fair results (12–14 points) in two patients.

We conclude that the use of this particular material provides satisfactory stability on the corrective osteotomy and because of its low profile it can be applied on the dorsal side on the radius without interfering with the extensor tendons.

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:

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

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.