Corrective Osteotomy for Isolated Malunion of the Palmar Lunate Facet in Distal Radius Fractures

Purpose Malunion of the palmar lunate facet fragment of distal radius fractures is associated with both early functional impairment and late degenerative changes. The goal of this study was to describe the clinical and radiographic outcomes after corrective osteotomy for isolated malunion of the palmar lunate facet. Methods Between 1995 and 2000, a retrospective review identified 13 patients with an average age of 44 years who had undergone corrective intra-articular osteotomy for isolated malunion of the palmar lunate facet. The average interval from the initial injury to the osteotomy was 5.4 months. Final evaluation was performed at 1 year. We performed statistical analysis using the Wilcoxon signed rank test. Results Wrist extension improved from an average of 53 degrees to 84 degrees (p = .002), flexion from 46 degrees to 61 degrees (p < .002), supination from 38 degrees to 87 degrees (p = .002), and pronation from 79 degrees to 87 degrees (p < .001). Grip strength improved from 30% to 73% of the contralateral side (p < .002). Disabilities of the Arm, Shoulder, and Hand scores improved from an average of 50.7 to 9.7 (p < .002). Palmar tilt improved from an average of 23 to 110 (p < .002). Radial inclination improved from an average of 29 degrees to 22 degrees (p < .002), ulnar variance decreased from +3.9 to -0.9 mm (p = .004), and intra-articular gap decreased from 3.6 to 0.9 mm (p < .002). All patients had excellent or good results according to both the Gartland and Werley and the Fernandez scoring systems. Conclusions Early intra-articular osteotomy significantly improved wrist range of motion, grip strength, Disabilities of the Arm, Shoulder, and Hand scores, and radiographic parameters. Patients reported mostly positive outcomes. (J Hand Surg 2010;35A:1779-1786. (C) 2010 Published by Elsevier Inc. on behalf of the American Society for Surgery of the Hand.)