[An assessment of the results of corrective osteotomy for malunited fractures of the distal radius].
BACKGROUND
Malunion is the most common and serious complications after fracture of the distal radius. Alterations of the normal biomechanics affect function of the wrist, which is associated with pain, disability and, in longer perspective, with arthrosis. Reestablishment of the normal anatomic relationships by corrective osteotomy is one of the most effective ways to prevent this scenario.


METHODS
Twenty-five consecutive patients, 19 women and 6 men with the mean age of 50 years with malunited fractures of the distal radius underwent corrective osteotomy. Operations were performed at mean of 8 months after precipitated fracture and indications included pain, reduction of wrist movement, loss of grip strength and wrist deformity. Regarding to direction of the dislocation, operations were done through a dorsal (20 patients) or volar (5 patients) approach, post-osteotomy defect in the distal radius was flied with cancellous bone graft form the iliac crest in 20 patients or allogenous bone graft in 5 patients and bone fixation was done with K-wires In 18 patients or with T-plate in 7 patients. The results were assessed at mean of 2 years with two standardized questionnaires: Gartland-Werley and DASH.


RESULTS
The average pre-operative DASH score was of 115 points (range 76-132) indicated severe disability of the hand. At the last follow-up assessment it decreased to a mean of 47 points (range 30-100) indicating statistically significant improvement the hand function. In Gartland-Werley scale, 9 patients (36%) achieved excellent, 11 (44%) good, 3 (12%) fair and 2 patients (8%) poor result. Two cases of poor results were caused by complications. Failure of the K-wires bone fixation with concomitant infection caused dislocation of the bone graft and collapse of the distal radius. In the second case, an allogenous bone graft did not heal, but disintegrated, what resulted in the total deformation of the distal radius.
Zyluk
Andrzej
A
Klinika Chirurgii Ogólnej i Chirurgii Reki, Pomorska Akademia Medyczna w Szczecinie. azyluk@hotmail.com
Niedźwiedź
Zygmunt
Z
D000328:Adult; D000368:Aged; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017759:Fractures, Malunited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010027:Osteotomy / Q000379:methods*; D017060:Patient Satisfaction; D011044:Poland; D011885:Radius Fractures / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome