Abstract
Introduction: We present our results from a series of patients with symptomatic distal radial malunions. Between January 2005 and October 2008, 15 patients (11 female: 4 male) underwent corrective osteotomy using fixed-angle plates and either structural iliac crest or inlay hydroxyapa-tite (HA) graft. 2 patients had correction for palmar, and the remainder for dorsal, angulation. The mean age was 48 years. The mean time from injury to corrective osteotomy was 12 months (range 3–40 months).
Methods: Radiological parameters included ulna variance, radial inclination, palmar angulation and time to union following osteotomy. Clinical outcomes included wrist RoM, grip strength, VAS for pain and DASH score (Disability of the Arm, Shoulder and Hand) preoperatively and 3 months post-operatively.
Results: The mean change in radiographic parameters were 2mm increase in ulnar variance, 9° increase in radial inclination (14° – 23°) and 23° increase in palmar angulation (−26° – 3°). The only statistically significant change in RoM was an increase in supination from 55° preoperatively to 73° postoperatively. DASH scores improved from a mean 51 pre-op to 15 post-op, statistically and clinically significant. The mean improvement in grip strength was 8kg, and the VAS for pain improved from 5 preoperatively to 1 postoperatively.
We found a positive correlation between age and time to union/graft incorporation (R2 = 0.47). The mean time to graft incorporation was 16 weeks. All of the patients treated with iliac crest structural graft progressed to union. Only 2 of the 4 patients treated with HA graft achieved incorporation, while the other 2 have required revision surgery.
Conclusion: Our results therefore show a significant improvement in both radiological and clinical outcome measures following corrective surgery. We had inferior results with the HA graft, and have subsequently abandoned its use. These results support the use of corrective osteotomy following distal radial malunion.
The abstracts were prepared by Mr Matt Costa and Mr Ben Ollivere. Correspondence should be addressed to Mr Costa at Clinical Sciences Research Institute, University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK.
