Description: OTA 2002 - Session 10 Session X - Upper Extremity Sun., 10/13/02 Upper Extremity, Paper #69, 11:00 AM *Corrective Osteotomy of Dorsally Malunited Fractures of the Distal
Radius via the Extended Flexor Carpi Radialis Approach Jorge L. Orbay, MD (d-Hand Innovations, Inc.); Alejandro
Badia, MD; Roger K. Khouri, MD; Eduardo González, MD; Diego L. Fernandez,
MD; Igor R. Indriago, MD; Miami Hand Center, Miami, Florida, USA; Lindenhof
Hospital, Berne, Switzerland Introduction: We were encouraged by the observation that volar
surgical approaches to the distal radius are better tolerated than dorsal;
therefore, we decided to treat symptomatic malunions of dorsally displaced
distal radius fractures with a corrective osteotomy performed through the
extended flexor carpi radialis (FCR) approach and stabilized with the DVR
fixed-angle plate. Here we present our experience with this technique. Methods: We reviewed retrospectively the records of all patients
who underwent corrective osteotomy of dorsally malunited distal radius fractures
at our center between October 1997 and October 1991 with use of the DVR
plate applied through the extended FCR approach. Indications for the procedure
were persistent pain, limitation of motion, and deformity more than 4 months
after union of dorsally displaced distal radius fractures. Standard radiographic
anatomical parameters were measured, and final functional results were assessed
by measuring digital motion, wrist motion, and grip strength. Results: All 26 patients (mean age, 42 years) that underwent this
procedure at an average of 9 months after their original injury were accounted
for and followed for an average of 70 weeks. Preoperative deformity averaged
20° of dorsal inclination, 9° of radial tilt, and 4 mm of radial
shortening. All the osteotomies healed with the following radiographic and
functional results. The final volar tilt averaged 8°; radial inclination,
20°; and radial shortening, 0 mm. The final average wrist flexion increased
23°, dorsiflexion increased 12°, forearm supination increased 18°,
and pronation increased 11°. Grip strength increased from 51% to 72%
of the contralateral side. There were 12 opening, 7 closing wedge, and 7
intrafocal osteotomies. Additional procedures consisted of 5 ulnar-shortening
osteotomies, 2 distal ulna resection arthroplasties, and 22 carpal tunnel
releases. Bone grafting was used in 19 patients. There were no tendon ruptures
or tenosynovitis, and no plate needed removal. Discussion and Conclusion: The use of a fixed-angle plate permits
corrective osteotomies for malunion of dorsally displaced distal radius
fractures through a volar approach. This technique avoids extensor tendon
complications and reduces the incidence of re-operation for plate removal.
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