title: Orthogonal Plate Fixation With Corrective Osteotomy for Treatment of Distal Radius Fracture Malunion.
abstract: OBJECTIVE
  To report outcomes of patients with distal radius fracture malunions treated with corrective osteotomy and orthogonal volar and radial "90-90" plate fixation.
  
  
  METHODS
  We performed a retrospective review of all patients who underwent distal radius corrective osteotomy and 90-90 fixation from January 2008 through December 2014. Demographic data, injury history, prior treatments, and clinical examination values were recorded. Preoperative radiographic measurements were used to classify the type and severity of deformity. The outcomes were patient-reported pain levels, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) functional scores, and radiographic outcomes. Secondary outcomes, including complications and the need for additional surgeries, were also noted.
  
  
  RESULTS
  Thirty-nine cases (31 extra-articular, 8 combined intra- and extra-articular) were included. At mean postoperative follow-up interval of 4 years, significant improvements were observed clinically in wrist flexion-extension arc, grip strength, pain, and Quick Disabilities of the Arm, Shoulder, and Hand scores. Radiographically, significant postoperative improvements were noted in ulnar variance, radial inclination, intra-articular stepoff, and radial tilt, with volarly and dorsally angulated malunions corrected to 9° and 7° of volar tilt, respectively. Twelve patients (31%) underwent additional surgery, the most common being plate removal in 7 patients, 3 of which involved removal of the radial plate.
  
  
  CONCLUSIONS
  For patients with symptomatic malunion of the distal radius, corrective osteotomy with 90-90 plate fixation is an effective treatment option for improving pain and restoring function for both volarly and dorsally angulated malunions, including malunions with an intra-articular component.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: The Philadelphia Hand Center, PC, Department of Orthopedic Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA. Electronic address: michaelpgaspar@gmail.com.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Gaspar
authors.affiliation: The Philadelphia Hand Center, PC, Department of Orthopedic Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA; Division of Orthopedic Surgery, Sutter Gould Medical Foundation, Modesto, CA.
authors.forename: Jenniefer Y
authors.initials: JY
authors.lastname: Kho
authors.affiliation: The Philadelphia Hand Center, PC, Department of Orthopedic Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Kane
authors.affiliation: The Philadelphia Hand Center, PC, Department of Orthopedic Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA; Department of Orthopaedic Surgery and Sports Medicine, Temple University Health System, Philadelphia, PA.
authors.forename: Hesham M
authors.initials: HM
authors.lastname: Abdelfattah
authors.affiliation: The Philadelphia Hand Center, PC, Department of Orthopedic Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA.
authors.forename: Randall W
authors.initials: RW
authors.lastname: Culp
mesh_terms: D001860:Bone Plates; D004185:Disability Evaluation; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Chronic deformity; corrective osteotomy; distal radius fracture malunion; orthogonal 90-90 plate fixation; radial- and volar-sided plating