Sliding osteotomy for deformity correction following malunion of volarly displaced distal radial fractures

Objective: To determine the outcome after a sliding osteotomy for deformity correction following malunion of volarly displaced distal radius fractures. Design: Retrospective review of a consecutive patient series. Setting: A university-affiliated, tertiary-care center. Patients/Intervention: Ten patients with symptomatic distal radius malunion following a volarly displaced distal radial fracture (Smith's fracture) were treated with an oblique sliding osteotomy and plate fixation, through a volar approach, without using an iliac crest bone graft. Five men and five women with an average age of 41.9 years were followed for an average of 2.7 years postoperatively. Main Outcome Measurements: Range of motion, grip strength, Fernandez wrist score, radiographic parameters. Results: At latest follow-up, wrist extension improved from an average of 37degrees preoperatively to 70degrees postoperatively (P = 0.002), wrist flexion improved from an average of 40degrees to 65degrees (P = 0.012), and supination improved from an average of 31degrees to 68degrees (P = 0.002). Postoperative radiographs revealed an average deformity correction of 10.6degrees of volar tilt, 7.7degrees of radial inclination, 5.8 mm of ulnar variance, and 10.4 mm of volar translation. Using the Fernandez point score (0-20) system, the average overall score improved from 10.5 preoperatively to 17.6 postoperatively (P = 0.0001). Functional outcome was rated as excellent or good in 9 of 10 patients and fair in 1 patient (who experienced residual problems due to persistent ulnar-sided pain). There were two reoperations (one hardware removal, one distal ulnar hemiresection). Conclusions: This method reliably restores distal radial anatomy, decreases pain, and improves supination without requiring iliac crest bone grafting.