Osteotomy of dorsally displaced malunited fractures of the distal radius - No loss of radiographic correction during healing with a minimally invasive fixation technique and an injectable bone substitute

Background and purpose Malunion after a distal radius fracture can be treated with an osteotomy of the distal radius. Often autologous iliac crest bone graft is used to fill the gap, but this is associated with donor site morbidity. Instead of bone graft, we have used a slow-resorbing bone substitute in combination with a minimally invasive fixation technique. Patients and methods 25 consecutive patients with a dorsal malunion after a distal radias fracture underwent an osteotomy. A TriMed buttress pin and a radial pin plate were used for fixation, and Norian SRS as bone substitute. The patients were followed for a minimum of 1 year and range of motion, grip strength, DASH scores, and the radiographic correction were measured. Results Forearm rotation improved from 137 degrees to 155 degrees, flexion/extension from 102 degrees to 120 degrees, and radioulnar deviation from 32 degrees to 43 degrees. Grip strength increased from 62% of the contralateral hand to 82%. DASH scores decreased from 36 to 23. Radiographically, all osteotomies but 1 healed and the radiographic correction achieved was consistent over the first year. Interpretation Osteotomy of the distal radius is effective in increasing motion and grip strength after a malunited distal radial fracture. Patient satisfaction is high and subjective results measured with DASH are good. Using a bone substitute, the operation can be performed as an outpatient procedure and donor-site pain avoided. No loss of the radiographic correction achieved was noted during osteotomy healing.