title: Gradual reduction of distal radial malunion using distraction osteogenesis.
abstract: OBJECTIVE
  To evaluate gradual distraction lengthening or distraction osteogenesis as a technique for treating malunions of the distal radius.
  
  
  METHODS
  Twenty patients with clinical and radiographic evidence of distal radius malunion were treated with osteotomy of the distal radius using distraction osteogenesis. At the follow-up evaluation each patient was evaluated for healing rates, complications, resolution of pain, and radiographic alignment. Surgical treatment consisted of an application of a nonbridging external fixator that could be distracted to correct the deformity. A loosely set screw that connected the distal pins to the fixator served as a hinge and allowed the distal radius to rotate into a corrected position. Gradual distraction via distraction osteogenesis was initiated 1 week after surgery.
  
  
  RESULTS
  Seventeen osteotomies healed uneventfully in an average of 9 weeks. Complications included 9 pin track infections. Two nonunions required bone grafting. One patient inadvertently compressed rather than distracted the fixator, leading to premature healing of the osteotomy. One patient ruptured the extensor pollicis longus. All complications resolved with additional intervention. Overall the patients showed radiographic and symptomatic improvement.
  
  
  CONCLUSIONS
  An external fixator and distraction lengthening through distraction osteogenesis is a viable alternative to plate fixation and bone grafting. In 18 of 20 of our patients, the technique eliminated the need for bone grafting and the need for a second surgical procedure to remove a dorsal plate.
authors.affiliation: Department of Orthopaedics, Hamot Medical Center, Erie, PA, USA. jdlubahn@adelphia.net
authors.forename: John D
authors.initials: JD
authors.lastname: Lubahn
authors.forename: John M
authors.initials: JM
authors.lastname: Hood
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Nechleba
authors.forename: D Patrick
authors.initials: DP
authors.lastname: Williams
authors.forename: Ted
authors.initials: T
authors.lastname: Green
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation; D005260:Female; D005500:Follow-Up Studies; D017759:Fractures, Malunited / Q000601:surgery*; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D007239:Infections / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000009:adverse effects / Q000379:methods*; D010027:Osteotomy; D017060:Patient Satisfaction; D011885:Radius Fractures / Q000601:surgery*; D013708:Tendon Injuries / Q000209:etiology / Q000601:surgery