Session X - Upper Extremity

*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.