[Malunion of the distal radius - long-term results after extraarticular corrective osteotomy].
OBJECTIVE
Numerous reports on short- and mid-term results demonstrate the value of corrective osteotomies for malunion of the distal radius. However, only long-term results can show whether a procedure has stood the test of time. Therefore the main questions to be answered in this article are: (i) are clinical and radiological improvements, recorded at short- and mid-term follow-up, long lasting? (ii) are consecutive procedures required, especially salvage procedures?; and (iii) what about the development of post-traumatic osteoarthritis?


METHODS
The study is based on the prospective data of 17 patients who underwent an extraarticular corrective osteotomy of the distal radius for symptomatic malunion (13 dorsal and 4 palmar malunions) between August 1992 and August 2003. The corrective osteotomy was performed as an opening wedge osteotomy filling the gap with an iliac crest bone graft and stabilisation of the radius with a plate. In 16 patients the radius was approached from palmar, in one patient the approach was dorsal. Preoperative, at short-term and at long-term postoperative follow-up clinical and radiological examinations were performed. In dorsal malunion the mean short-term follow-up was 17±10 (range: 7-44) months, and the mean long-term follow-up was 157±51 (120-254) months. In palmar malunion, the short-term follow-up averaged 13±6 (7-20) months, and the long-term follow-up 150±10 (138-166) months.


RESULTS
All osteotomies showed bony union. One patient had to be excluded from the long-term evaluation due to wrist fusion and ulnar head hemiresection after 15 years. After dorsal malunion the long-term results showed a lasting improvement for all parameters. A comparison of short-term and long-term results revealed no deterioration of the results but a further statistically significant improvement in grip strength. 7 patients had no osteoarthritis, 3 osteoarthritis 1°, 1 osteoarthritis 2°, and 1 osteoarthritis 3°. After palmar malunion improvements occurred and lasted in the long-term run, but were not statistically significant. In this group no osteoarthritis was present.


CONCLUSIONS
Corrective osteotomy for malunion of the distal radius has stood the test of time even in the long-term course. Even from this point of view, it can be recommended.
Klinik für Handchirurgie, Rhönklinikum, Bad Neustadt/Saale.
T
T
Pillukat
Klinik für Unfallchirurgie und Wiederherstellungschirurgie, Universitätsklinikum RWTH Aachen, Aachen.
G
G
Gradl
Klinik für Handchirurgie, Rhönklinikum, Bad Neustadt/Saale.
M
M
Mühldorfer-Fodor
Klinik für Handchirurgie, Rhönklinikum, Bad Neustadt/Saale.
K-J
KJ
Prommersberger
D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation; D017102:Fracture Healing / Q000502:physiology; D017759:Fractures, Malunited / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D011446:Prospective Studies; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D012086:Reoperation; D014954:Wrist Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D055815:Young Adult