Takuro Wada1, Masahiro Tatebe2, Yasuhiro Ozasa1, Osamu Sato3, Tomoko Sonoda4, Hitoshi Hirata2, Toshihiko Yamashita1. 1. Department of Orthopaedic Surgery, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan. E-mail address for T. Wada: twada@sapmed.ac.jp. E-mail address for Y. Ozasa: ozasa.yasuhiro@mayo.edu. E-mail address for T. Yamashita: tyamasit@sapmed.ac.jp. 2. Department of Hand Surgery, Nagoya University, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan. E-mail address for M. Tatebe: tatebe@med.nagoya-u.ac.jp. E-mail address for H. Hirata: h-hirata@med.nagoya-u.ac.jp. 3. Orthopaedic Clinic, Hakodate Goryokaku Hospital, 38-3, Goryokaku-cho, Hakodate 040-8622, Japan. E-mail address: semeru2005@ninus.ocn.ne.jp. 4. Department of Public Health, Sapporo Medical University, South 1, West 17, Chuo-ku, Sapporo 060-8556, Japan. E-mail address: tsonoda@sapmed.ac.jp.
Abstract
INTRODUCTION: We describe a technique consisting of simultaneous radial closing-wedge and ulnar shortening osteotomy to treat malunion of distal radial fractures. STEP 1 PREOPERATIVE PLANNING: Plan the radial closing-wedge osteotomy to correct the volar tilt angle to 8.5° to 15.5° and the ulnar shortening osteotomy to restore ulnar variance to -2.5 to 0.5 mm. STEP 2 RADIAL CLOSING-WEDGE OSTEOTOMY: Remove the wedge of bone from the radius and reduce the distal fragment, keeping the dorsal cortex as a hinge. STEP 3 DISTAL ULNAR SHORTENING OSTEOTOMY: Resect the section of the ulna equivalent to the positive ulnar variance with transverse osteotomies. STEP 4 PLATE FIXATION OF THE RADIAL OSTEOTOMY SITE: Hold together the two fragments of the radius with a Kirschner wire and fix the osteotomy site with a volar locking plate. STEP 5 PROXIMAL ULNAR SHORTENING OSTEOTOMY: Evaluate residual ulnar positive variance with fluoroscopy and restore the ulnar variance to within a normal range by removing additional bone from the proximal fragment. STEP 6 PLATE FIXATION OF THE ULNAR OSTEOTOMY SITE: Use a compression device to close and fix the ulnar osteotomy site. STEP 7 POSTOPERATIVE MANAGEMENT: Allow early motion immediately after the operation. RESULTS: We retrospectively evaluated forty-two patients at a minimum of one year after treatment of an extra-articular distal radial malunion with a radial corrective osteotomy. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: We describe a technique consisting of simultaneous radial closing-wedge and ulnar shortening osteotomy to treat malunion of distal radial fractures. STEP 1 PREOPERATIVE PLANNING: Plan the radial closing-wedge osteotomy to correct the volar tilt angle to 8.5° to 15.5° and the ulnar shortening osteotomy to restore ulnar variance to -2.5 to 0.5 mm. STEP 2 RADIAL CLOSING-WEDGE OSTEOTOMY: Remove the wedge of bone from the radius and reduce the distal fragment, keeping the dorsal cortex as a hinge. STEP 3 DISTAL ULNAR SHORTENING OSTEOTOMY: Resect the section of the ulna equivalent to the positive ulnar variance with transverse osteotomies. STEP 4 PLATE FIXATION OF THE RADIAL OSTEOTOMY SITE: Hold together the two fragments of the radius with a Kirschner wire and fix the osteotomy site with a volar locking plate. STEP 5 PROXIMAL ULNAR SHORTENING OSTEOTOMY: Evaluate residual ulnar positive variance with fluoroscopy and restore the ulnar variance to within a normal range by removing additional bone from the proximal fragment. STEP 6 PLATE FIXATION OF THE ULNAR OSTEOTOMY SITE: Use a compression device to close and fix the ulnar osteotomy site. STEP 7 POSTOPERATIVE MANAGEMENT: Allow early motion immediately after the operation. RESULTS: We retrospectively evaluated forty-two patients at a minimum of one year after treatment of an extra-articular distal radial malunion with a radial corrective osteotomy. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.