Session II - Upper Extremity
Outcome Evaluation of 3-D Correction for Post-Traumatic Deformity of the Distal Radius
Marci D. Jones, MD; Thomas E. Trumble, MD; Mary Gilbert MA; University of Washington, Seattle, WA
Purpose: This prospective study evaluated the results following 3-dimensional (3-D) osteotomy of the distal radius, using both radiographic and range-of-motion measurements, as well as the DASH questionnaire. The hypothesis was that a 3-D osteotomy would improve functional outcome and objective measurements.
Methods: Twenty patients with dorsally angulated malunions following distal radius fracture and a minimum follow-up of 2 years (24-45 months, mean 35 months) were evaluated pre- and postoperatively for range of motion, grip strength and with the DASH questionnaire. Pre-, post-reduction and final radiographs were evaluated for palmar tilt (PT), radial tilt (RT), and radial length (RL). Patients were included if pre-operative radiographs showed -15° PT (mean -22°, range -15° to -40°), with loss of RT averaging 9°, and RL averaging 6 mm. There were 13 women, and the average age was 35 years (range 20-48 years). Patients were treated with corrective osteotomy in all 3 planes of deformity with iliac crest bone graft and dorsal plate fixation.
Results: Clinical measurements showed significant improvement in all areas (Table). Radiographic measurements also improved in all 3 planes, with correction maintained at final follow-up. PT improved from 22° preoperatively to 3° post-operatively (P = 0.0001), RT improved from 9° pre-operatively to 19° post-operatively (P = 0.0001), and RL improved from 6 mm pre-operatively to 0 mm (P = 0.0001). DASH scores showed significant improvement with overall score decreasing from 2.6 to 1.7 (P = 0.0001). DASH scores in individual domains improved significantly in all but 7 areas (turn a key, make bed, change light bulb, pull on sweater, cut food with knife, recreational activity (little effort) and manage transportation). The most significant improvement occurred in carrying (bag and >10 lbs.),
and nonspecific areas (limited work activity, severity of pain, weakness, stiffness, and loss of confidence). DASH scores significantly worsened in 2 areas (tingling, sleep difficulty).
Conclusion: Corrective 3-D osteotomy improves patient function as measured by outcome questionnaire and objective radiographic and clinical measurements.
Significance: Distal radius malunion can be successfully treated by 3-D osteotomy, with expected improvement in functional outcome as well as clinical and radiographic measurements.