Corrective Osteotomy with Volar and Dorsal Fixation for Malunion of Intra-Articular Fracture of the Distal Radius: A Retrospective Study

Objectives Although corrective osteotomy with volar or dorsal plate fixation can treat malunion of distal radius fractures, each has its own disadvantages. Little is currently known on whether dorsal fixation combined with volar fixation may further improve recovery. This study aimed to evaluate the clinical value of corrective osteotomy combined with volar and dorsal plate fixation in patients with malunion of intra-articular fractures of the distal radius. Methods Seventeen patients with malunion of intra-articular fractures of the distal radius treated with corrective osteotomy with volar and dorsal plate fixation from 1 January 2016 to 31 November 2018 were retrospectively analyzed. The enrolled patients included seven males and 10 females with an average age of 54.9 years (range: 36-70 years). The radiographic parameters, including the radial length, the radial inclination angle, the ulnar variance, and the volar tilt, as well as clinical outcomes, including wrist and forearm range of motion (ROM), grip strength, the Mayo Modified Wrist Score (MMWS), and the disabilities of the Arm, Shoulder, and Hand (DASH) score, were examined at 3 months and 18 months after operation and compared with the preoperative state. The paired t-test was used for statistical analysis. Results After corrective osteotomy combined with volar and dorsal plate fixation, all included patients were followed up for 18 months, and there was no surgical site infection. Patients reported postoperative pain due to the irritation of extensor tendon (two cases) and wrist arthritis (two cases). The radial length increased from 1.34 +/- 2.34 mm to 9.25 +/- 2.65 mm and 9.03 +/- 2.47 mm at 3 months and 18 months postoperatively (t = 8.257, 7.954, all p < 0.05). The radial inclination angle increased from 6.45 degrees +/- 0.76 degrees to 19.35 degrees +/- 3.43 degrees and 19.03 degrees +/- 3.63 degrees at 3 and 18 months (t = 12.517, 12.122, all p < 0.05). The ulnar variance decreased from 5.11 +/- 0.23 mm to 1.32 +/- 0.31 mm and 1.54 +/- 0.62 mm at 3 and 18 months (t = 4.214, 4.895, all p < 0.05). The volar tilt was corrected from 4.47 degrees +/- 3.46 degrees to 15.51 degrees +/- 2.72 degrees and 14.12 degrees +/- 2.41 degrees, respectively (t = 11.247, 10.432, all p < 0.05). Moreover, wrist ROM increased from 42.53 degrees +/- 8.99 degrees to 98.70 degrees +/- 7.61 degrees and 101.24 degrees +/- 7.66 degrees (t = 41.433, 46.627, all p < 0.05), while forearm ROM was increased from 94.82 degrees +/- 6.54 degrees to 134.47 degrees +/- 5.06 degrees and 137.24 degrees +/- 5.52 degrees, respectively (t = 31.507, 32.584, all p < 0.05). Similarly, grip strength, MMWS, and DASH were also remarkably improved. There were no significant differences in the wrist and forearm ROM, grip strength, MMWS, and DASH scores between follow-up at 3 and 18 months (all p > 0.05). Conclusions Corrective osteotomy with volar and dorsal fixation can improve recovery of volar tilt, relieve wrist pain, restore wrist and forearm function, and increase grip strength of patients with malunion of intra-articular fractures of the distal radius.

Automated summary

This study retrospectively analyzed the clinical and imaging parameters of 17 patients with malunion of intra-articular fractures of the distal radius treated with corrective osteotomy combined with volar and dorsal plate fixation, and found that postoperative wrist and forearm function, grip strength, and scores improved significantly.