Outcomes using an internal osteotomy and distraction device for corrective osteotomy of distal radius malunions requiring correction in multiple planes.
OBJECTIVE
Many different methods have been proposed for correction of distal radius malunions; however, precise correction of a severe malunion that requires simultaneous adjustment of displacement, angulation, and rotation in multiple planes is difficult. This prospective study measured radiographic and functional outcomes using an adjustable osteotomy, distraction, and fixation system for distal radius malunions that required correction in multiple planes.


METHODS
Five consecutive patients with symptomatic distal radius malunions requiring correction in multiple planes were recruited into this study. All patients had correction of the malunion with an adjustable osteotomy, distraction, and fixation device. Radiographic parameters and objective and subjective functional outcomes were measured before surgery and at 3 months, 6 months, and 1 year after surgery.


RESULTS
All radiographic measurements improved after surgery. Grip strength, pinch strength, and the Jebsen-Taylor test showed only marginal improvement. Ulnar deviation of the wrist and forearm pronation-supination improved, but the wrist extension-flexion arc did not. The Michigan Hand Outcomes Questionnaire showed improvement in all domains, and significant improvement was seen in the overall, work, aesthetic, and satisfaction domains. The Michigan Hand Outcomes Questionnaire, however, also indicated a substantial amount of residual impairment in all domains, including activities of daily living and pain.


CONCLUSIONS
Corrective osteotomy with the adjustable osteotomy, distraction, and fixation device resulted in improvement in distal radius anatomy and function. However, not all improvements were statistically significant, and anatomy and function did not returned to baseline levels. Despite residual disability, patients noted substantial improvement in subjective outcomes. This system is useful for improving anatomy and function in distal radius malunions that require correction in multiple planes, but patients should be informed that they cannot expect to regain normal anatomy or function.


METHODS
Therapeutic IV.
Sammer
Douglas M
DM
Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI 48109-0340, USA.
Kawamura
Kenji
K
Chung
Kevin C
KC
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D016025:Bone Transplantation; D004954:Esthetics; D005260:Female; D005593:Fracture Fixation, Internal; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000295:instrumentation* / Q000379:methods*; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011403:Pronation / Q000502:physiology; D011446:Prospective Studies; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D013484:Supination / Q000502:physiology; D011795:Surveys and Questionnaires; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery