The objective findings and subjective complaints of a symptomatic malunion have come to be better appreciated as patients of all ages have demand ed high levels of function after this common injury. Corrective osteotomy of distal radius malunionnew horizons. Midcarpal instability caused by malunited fractures of the. In formulating a treatment plan, the surgeon also must consider such technical variables as the type of osteotomy, the use of bone graft or bonegraft substitute, and the means of fixation to stabilize the osteotomy. Midcarpal instability caused by malunited fractures of the distal radius thirteen patients with malunited fractures cf the distal radius developed symptoms of pain and instability of the midcarpal joint. Ultrasound evaluation of carpal tunnel and median nerve in.
It also occurs in young men with high velocity, injury. Malunion of the humeral shaft malunited humeral shaft fractures. Corrective osteotomy after malunited distal radius. The most common deformity following a malunited extraarticular fracture of the distal radius is the loss of the normal palmar tilt of the articular surface in the sagittal plane, and loss of length relative to the ulna. Symptoms include pain, bruising, and rapidonset swelling. One of the most common complications following distal radius fractures is still malunion of the distal radius. In 1112 patients, mean time from fracture to osteotomy was 168 days. Modality of treatment for the distal end radius fracture dr bhuvnesh chaturvedi, dr sk irfan ali, dr sumit krishna abstract fracture of the distal end of radius is one of the most common fractures. Threedimensional computerassisted corrective osteotomy. Patient satisfaction is high and subjective results measured with dash are good. Current trends in the management of distal radius fractures. She underwent open reduction and fixation of the distal radius fracture, and current radiographs are shown in figure b. Best approaches in distal radius fracture malunions ncbi. This distal radius fracture eventually developed into a malunion.
The overall complication rate of distal radius fractures ranges from 6% to 80% and has been associated with poor functional outcomes. Early correction of paediatric malunited distal metaphyseal radius. These include malunion, degenerative osteoarthritis in the radiocarpal joint and subsequently pain and impaired hand function. Reconstruction of malunited diaphyseal fractures of the. In the presence of severe radial shortening and decreased radial inclination, they. The epidemiology of distal radius fractures hand clin 2012. Major complications of distal radius fractures include carpal. Typically, these breaks occur when a persons fall causes them to land on outstretched hands.
Reestablishing the geometry of the metaphysis and the alignment of the articular surface, restoring the relationship at the distal radioulnar joint, and respecting the softtissue envelope are elements of. W1 role of advanced imaging in distal radius fractures. Pa and lateral of a malunited distal radius fracture with some loss of radial height and inclination with significant dorsal tilt and adaptive disi. Modality of treatment for the distal end radius fracture. Pa and lateral of a malunited distal radius fracture with some loss of radial height and inclination with significant dorsal tilt and adaptive disi deformity while malunion can result in multiple changes in mechanics and may ultimately lead to arthrosis, the decision to perform a corrective osteotomy for a distal radius malunion should generally be based on the patients overall functional capacity and symptoms. Distal radius fractures are among the most common fractures in the body, usually occurring as a result of a fall. When bone graft is required, this may necessitate a separate incision and further add to the morbidity. Ulnar shortening osteotomy after distal radius fracture. Malunions of the distal radius not all distal radial malunions are symptomatic, especially those in. Median neuropathy and tendon attrition or rupture can be late sequelae3. Ppt distal radius fractures powerpoint presentation. Here, we present our experience and early results with arthroscopic resection arthroplasty of the radiocarpal joint.
Open wedge corrective osteotomy of malunited distal radius fractures through a palmar approach. The malunited distal radius fracture early or late. The objective findings and subjective complaints of a symptomatic malunion. Opening wedge osteotomy for volarly malunited distal radius fracture restored bony configuration of the distal radius, decreased pain, and improved grip strength and range of wrist motion. Malunion after a distal radius fracture can be treated with an osteotomy of the. Figure w12 anterior volumerendered 3d reformatted image from a multidetector ct examination allows improved appreciation of the degree of fracture displacement of the distal radius, allowing the clinician to anticipate surgical findings frequently, subtle radiographic lucencies of the distal radius may simulate fractures and are a cause for inconclusive, or even incorrect, reporting. There is limited evidence regarding the relationship between distal radius deformity and stiffness or pain. Distal radius fractures, first described in the 18th century by petit 1 and pouteau 2 commonly account for 10% of all fractures 3 and 72% of all forearm fractures. Deml c 2018 arora r 2018 comparison of volarly and dorsally displaced distal radius fracture treated by volar locking plate fixation. Malunion following treatment of distal radius fractures continues to be a significant. Complications of distal radius fracture fixation may arise from the injury or method of treatment, as well as both. Staged reconstruction for malunited fractures of the.
Pdf rotational deformity in malunited fractures of the. Threedimensional computerassisted corrective osteotomy techniques for the malunited distal radius 223 jupiter et al. Distal radius fracture problems can arise from complications related to the soft tissues, bony anatomy, joints and hardware. They recommend uso for the surgical treatment of uca after malunited distal radius fracture, for which the main deformity is moderate radial shortening with a normal radial inclination. Abstract malunion of a distal radius fracture may result in functional limitation and pain. Interpretation osteotomy of the distal radius is effective in increasing motion and grip strength after a malunited distal radial fracture. Distal radius fracture is one of the most common fractures accounting for around 25% of fractures in the pediatric population and up to 18% of all fractures in the elderly age 1 nellans kw, kowalski e, chung kc. Surgical technique of corrective osteotomy for malunited. The goal of this study was to assess bone healing and secondary fracture displacement in the treatment of malunited distal radius fractures without the use of bone grafting. Note the dorsal posture of the lunate and the increases in the scapholunate angle and the capitolunate angle. Two cohorts of 10 patients who had a corrective osteotomy for a malunited fracture of the distal radius with a pishaped plate and screw fixation were compared retrospectively to see whether the.
Surgical correction of malunited fractures of the distal radius. Furthermore, the central three fifths of the radius form the major lateral convexity of the radius 53. Corrective osteotomy to restore normal anatomy usually provides improved function and significant pain relief. Pdf do young patients with malunited fractures of the. The conventional corrective osteotomy for malunited distal radius fracture that employs dorsal approach and insertion of a trapezoidal bone graft does not. We carried out a clinical and radiological assessment at a mean followup of 38 years 33 to 42. In the case of malunited fracture, particularly in younger and more active patients with no arthritic changes, openwedge corrective osteotomy with bone autograft is indicated 1, 10, 16, 17, 19, 20. The purpose of this study was to assess range of motion rom, pain, and incidence of radiographic degenerative joint disease djd after volar radioscapholunate rsl arthrodesis and distal scaphoidectomy dse following malunited distal radius fractures drf. Candidates for this retrospective analysis were consecutive patients who underwent corrective osteotomy with a corticospongious bone autograft due to malunited distal radial bone fracture over the two years before the decision to modify our practice and, hence, underwent the standard or control procedure, or during the subsequent two years after the decision to modify the practice and, hence, underwent the test procedure that included implantation of the graft into a periosteal bed. Corrective osteotomy of the radius was performed in all 12 patients between 2005 and 2012. Osteotomy of distal radius fracture malunion using a fast remodeling.
Anatomically, the middle third is the zone where both forearm bones overlap at extreme pronation and supination. At the time of the index operation, there was no distal radioulnar joint. The radius is the most commonly broken bone in the arm. The close proximity of the median nerve to the distal part of the radius and its confinement within the carpal tunnel, predisposes it to injury. We report the outcomes in a caseseries with special attention to the potential influence of the initial management.
Best approaches in distal radius fracture malunions. Dexa scan is recommended for women with distal radius fractures. Fractures of the distal radius occurring in young adults are treated increasingly by open surgical techniques, partly because of concern that failure to restore the alignment of the fracture accurately may cause symptomatic posttraumatic osteoarthritis in future years. A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Indications for surgical treatment of distal radius fractures drf remain controversial in the literature, especially in elderly patients. Effect of malunited fractured distal end of radius. Complication rates after operatively treated drf are low and well documented. Orthogonal plate fixation with corrective osteotomy for treatment. Recent trends in treatment of malunited fracture distal radius. Osteotomy of dorsally displaced malunited fractures of the.
Rotational deformity in malunited fractures of the distal radius. Nineteen patients had a fracture of the distal onequarter of the radius and two had a salter grade ii injury. In six cases, a recurrent voluntary midcarpal subluxation was also present during ulnar deviation. Surgical technique of corrective osteotomy for malunited distal.
Salvage procedure after malunited distal radius fractures. Reconstruction of malunited distal radius fracture. Corrective osteotomy using a volar locking plate has recently become an alternative technique. Treatment of malunited distal radius is corrective osteotomy of the. B,normal radiocarpal and intercarpal alignment in the sagittal plane. Corrective osteotomy of the malunited distal radius. After a severe trauma, a 16yearold female patient sustained multiple injuries, including a distal radius fracture of the left arm. The one, two or three stage concept of reconstructing the malunited distal end radius could optimise the outcome rather than using a singlestage strategy. This can be altered with fracture of the distal radius 15, 17. Te, tencer, af the effects of distal radius fracture malalignment on forearm rotation. Using a bone substitute, the operation can be performed as an outpatient procedure and donorsite pain avoided. Malunion is a recognized cause of suboptimal function after distal radius fracture. Cartilage damage of the carpals is a contraindication for corrective osteotomy of the malunited intraarticular distal radius fracture and typically is treated in the symptomatic patient with a salvage procedure. Distal radius fractures a free powerpoint ppt presentation displayed as a flash slide show on id.
Schematic representation of a malunited distal radius fracture treated with corrective osteotomy and 9090 plate fixation. Anatomy the distal radius is biconcave,triangular, and covered withhyaline cartilage. Distal radius malunion is a major complication of distal radius fractures, reported in 0 to 33% of cases. Th trapezoidal osteotomy of the distal radius for unacceptable articular angulation after colles fracture journal of hand surgery. A malunited colles fracture causes distortion of three anatomic features of the distal radius. Osteotomy for extraarticular malunion of the distal radius. Volar plate fixation of distal radius fractures jorge orbay, md miami hand center, 8905 southwest 87 avenue, suite 100, miami, fl 33176, usa reliable internal. Finally, the extended position of the lunate and the scaphoid may result in a. Malunion is the most common complication of the distal radial bone fracture and results in pain and reduced hand strength and function 2, 3, 21, 22. In younger people, these fractures typically occur during sports or a motor vehicle collision.
The prospective populationbased cohort study included 143 consecutive patients above 18 years with an acute distal radius fracture treated with closed reduction and either cast 55. Carpal instability, malunion among complications of distal. The conventional corrective osteotomy for malunited distal radius fracture that employs dorsal approach and insertion of a trapezoidal bone graft does not always lead to precise correction or result in a satisfactory surgical outcome. Pdf malunited extraarticular distal radius fractures. Distal radius, osteotomy, radioulnar joint, malunion. Relationship between distal radius fracture malunion and. Malunion of the distal radius usually occurs following conservative treatment. Malunion following distal radius fracture is a common complication that can hinder wrist and forearm motion and can contribute to postraumatic arthritis, carpal malalignment, ulnocarpal impaction, and instability or incongruity of the druj. Staged reconstruction for malunited fractures of the distal radius. Arthroscopic resection arthroplasty for malunited intra. Anterolateral surgical approach to the malunited distal. Fracture malunion has been shown to associate with altered morphometric anatomy of distal radioulnar joint. In the other hand, unstable fracture easily becomes malunited with inadequate treatment. In this case, we demonstrate our preoperative lowcost workup for threedimensional 3d planned and assisted corrective osteotomy of a malunited distal radius fracture using an inhospital 3d printer.
We present an alternative anterolateral surgical approach to the distal radius, which allows for excellent exposure, and minimal trauma to the tendons while permitting harvest of local bone graft through the same incision. Do young patients with malunited fractures of the distal. Staged reconstruction for malunited fractures of the distal radius show all authors. Surgical technique of corrective osteotomy for malunited distal radius fracture using the. Proper understanding of anatomy, biomechanics, indications, and contraindications can help guide patient selection for surgery.
Management of malunions of the distal radius request pdf. The purpose was to investigate the relationship between distal radius fracture malunion and armrelated disability. Callus osteoclasis, radius fractures, malunion, child wrist fracture. The full text of this article is available in pdf format. Surgical correction of malunited fractures of the distal. It occurs in middle aged and elderly women commonly. Identification of neurological deficits secondary to fracture distal radius, necessitates alternative treatment methods to enhance neurological recovery and to improve functional results.