Simultaneous radial closing wedge and ulnar shortening osteotomies for distal radius malunion.
OBJECTIVE
Closing wedge osteotomies are an attractive treatment option for distal radius malunion in patients with osteopenia; however, they require an ulnar head resection to accommodate closure of corrective osteotomy and to address the issue of ulnocarpal abutment. The literature contains little information on concomitant ulnar shortening osteotomy despite a physiologic solution. We report the functional and radiographic outcomes of 5 patients treated for symptomatic distal radius malunion with simultaneous radial closing wedge and ulnar shortening osteotomies.


METHODS
All 5 patients were women aged 52 to 69 years (average, 61 years). Four patients had extra-articular radius fractures with dorsal angulation (20-22 degrees ) and shortening (3-7/mm); the other had the fracture with volar angulation (24 degrees ) and shortening (11 mm). Through a volar approach an appropriate amount of bone wedge was removed from the distal radius. A small volar T-plate was used to secure the osteotomized bone fragment. Six to 11 mm of ulnar shortening osteotomy was performed by using transverse osteotomy and compression plating technique with an AO compression device.


RESULTS
In all 5 wrists healing of radial and ulnar osteotomies occurred less than 3 months after surgery. There were no postsurgical complications. Postsurgical radiographs showed that the volar tilt angle of the radius was reduced to normal range (range, 8-15 degrees ) in all wrists. The ulnar variance was 0 mm in 4 wrists and 2 mm in 1 wrist. There were significant improvements in pain, function, and range of motion at an average follow-up evaluation of 17 months. The average grip strength as a percentage of the opposite side improved from 30% before to 73% after surgery.


CONCLUSIONS
This study showed that closing wedge osteotomy of the radius concomitant with ulnar shortening osteotomy is technically and functionally adequate. Our procedure is indicated for patients with osteopenia for whom opening wedge osteotomy of the radius is inadequate.
Wada
Takuro
T
Department of Orthopaedic Surgery, Sapporo Medical University, School of Medicine, South 1 West 16, Sapporo 060-8543, Japan.
Isogai
Satoshi
S
Kanaya
Kohei
K
Tsukahara
Tomohide
T
Yamashita
Toshihiko
T
D000368:Aged; D001851:Bone Diseases, Metabolic / Q000601:surgery; D001860:Bone Plates; D001864:Bone Wires; D005260:Female; D017102:Fracture Healing; D017759:Fractures, Malunited / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011885:Radius Fractures / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D014457:Ulna / Q000601:surgery*; D014955:Wrist Joint / Q000503:physiopathology