Session X - Upper Extremity

Sun., 10/13/02 Upper Extremity, Paper #68, 10:54 AM

*The Role of Distal Radial Osteotomy in the Restoration of Wrist and Hand Function

Margaret M. McQueen, MD, FRCS; Alison Wakefield, MSc, MCSP; Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (a-Stryker Howmedica Osteonics)

Purpose: Malunion is a common complication of distal radial fracture that may result in pain, loss of function, and posttraumatic arthritis. Distal radial osteotomy with bone graft and external fixation is an accepted corrective technique for the treatment of this complication. This prospective study examined functional outcome after treatment with a novel less-invasive surgical technique.

Methods: Twenty-three patients with malunion after distal radial fracture underwent distal radial osteotomy with use of a dorsal opening wedge with cancellous bone grafting through a 3-cm transverse dorsal incision. The position was maintained by using the Hoffman II nonbridging external fixator for 6 weeks. The range of movement, grip strength, wrist and hand function, and radiographs were examined at 6 weeks, 3 months, and 6 months postoperatively and compared with preoperative values. Quality of life measurements were assessed with the SF-36 questionnaire. Data (mean ± SEM) were compared with use of the Wilcoxon signed-rank test, with significance set at 5%.

Results: Surgery improved dorsal angulation from 19.5 (2.22) to ­6.4 (1.4) P <0.001. All components of wrist movement were significantly improved from the 3-month examination (P <0.05). Grip strength increased from 27% of the unaffected side to 56% at 6 months (P <0.05), and the functional score improved from 72% to 92% of the unaffected hand (P <0.001). Patients reported a significant reduction in pain and were much more satisfied with the cosmetic appearance of their wrist; quality of life also improved significantly. Surgical morbidity included 13 minor pin tract infections, two patients had a spontaneous rupture of the extensor pollicis longus tendon, and two needed further ulnar procedures for distal radioulnar joint symptoms.

Conclusion: The minimally invasive distal radial osteotomy with nonbridging fixation was successful in restoring anatomic position, decreasing pain, and improving wrist and hand function in patients with malunion of distal radial fractures. Early functional improvement provided evidence for the efficacy of this technique.