A09 Distal radius malunion - two bone osteotomy and factors affecting decision making

Autoři/Authors: Kebrle R.(1), Vodička Z(2)

Pracoviště/Workplace: (1) UPCHR Vysoké nad Jizerou, Czech Republic, (2) Ortopedické oddělení, Nemocnice České Budějovice

Délka prezentace/presentation time: 7 min.

Summary:

Introduction: Distal radius malunion covers “easy” angular or rotational malunions as well as malunions appearing after high energy injury, infection of the fracture or malunions with previous multiple surgical procedures. In certain situations soft tissues are very tight or over all situation is so complicated that simple radial corrective osteotomy is not enough for a good functional result. That is why authors are trying to find factors that do influence decision making whether to do just radial or combined radial and concomitant ulnar osteotomy.

Methods: Authors are presenting group of 10 patients treated with two bone osteotomy at the same time. Pre and postoperative X rays, range of motion, grip strength where studied and all aditional clinical problems where described in this group.

Results: Group analysis revealed that 4 fractures where open, 5 where high energy injuries, 2 where infected, 8 patients had 2-4 previous surgical procedures and 4 had concomitant neurological, vascular or tendon problem preoperatively. Deformities varied from 2-20 mm of radial shortening, 70 degrees of volar to 55 of dorsal angulation and minus 20 to plus 18 degrees of ulnar inclination. Extension of the wrist averaged 31 degrees, flexion 34 degrees, supination 34 degrees and forarm pronation 34 degrees. The average grip strentgh was of 17 kilograms compared to 33 on contralateral side.
At an average of 10,8 months (range, 6 to 17 months) radial shortening improved from 9,9mm to 0,8mm, volar inclination improved to 14,3 degrees and ulnar inclination to 14,9 degrees. Range of motion changed from  34 to 59 degrees of  extension, 31 to 46 degrees of flexion, 34 to 62 degrees of supination and 34 to 65 degrees of pronation. Grip strength improved from 17,25 to 31,25 kg.

Discussion: Concomitant radius and ulnar osteotomy is a big surgery but valuable way of treatment of distal radius malunion in cases of severe soft tissue impairment as it happens in cases of high energy and open injuries, in previously infected cases and in cases after multiple surgeries. All these factors are aggravating soft tissue tension and increasing risk of postoperative stiffness. 9 patients have had different types of bony procedures, soft tissue complications or algodystrophy. All needed individual approach and type of osteotomy but all have had reasonable functional and cosmetic improvement.