Correction of nascent malunion of distal radius fractures

Objective: Early correction of malunion of distal radius fractures may be necessary in young, active patients. The aim of this study was to report the advantages and disadvantages of early correction of distal radius malunion. Methods: Eleven patients (10 male, 1 female; average age 36 years, range: 20 to 54 years) with nascent malunion of distal radius fractures were included in this study. The malunions occurred after initial conservative treatment of unstable distal radius fractures. Mean interval between injury and corrective surgery was 12 (range: 8 to 15) weeks. Two patients had intra- and extra-articular malunion and 9 had an extra-articular malunion. Volar correction was made in seven patients and dorsal correction in four. Results were evaluated radiologically and functionally using the Mayo wrist score. Results: Bony healing was established after correctional osteotomies at an average of 8 (range: 5 to 16) weeks. The average preoperative dorsal deformity was 28 degrees and was corrected to 4 degrees of volar tilt postoperatively. Patients had a positive ulnar variance with an average of 5 mm initially and less than 1 mm postoperatively. Radial inclination was corrected from an average of 9 degrees preoperatively to an average of 20 degrees and the average postoperative Mayo wrist score was 82.5. Tenotomy of brachioradialis was useful for the correction of radial inclination, especially in old cases. Structural (corticocancellous) grafting was used in one patient. All patients returned to their previous functional level. Conclusion: Advantages of early corrective osteotomy include anatomic restoration at the original fracture line, a shortened healing period and a decreased need for structural bone grafting. Disadvantages are that the recreation of the original fracture line is technically demanding and patients must be cooperative to achieve a successful outcome.