A comparison of corrective osteotomies using dorsal and volar fixation for malunited distal radius fractures
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This study aimed to compare clinical results and to restore radiographic parameters of corrective osteotomy for malunited distal radius fracture using a volar locking plate with a dorsal plate.
We retrospectively studied 28 consecutive patients with symptomatic malunited distal radius fractures followed up for more than 12 months who underwent corrective osteotomy with a dorsal buttress plate (n = 9) or a volar locking plate (n = 19). Volar tilt (VT), radial inclination (RI), and ulnar variance (UV) were radiographically evaluated. Clinical examination parameters included pain, wrist and forearm ranges of motion (ROM), grip strength, and Mayo Modified Wrist Score (MMWS).
The volar group had a significantly greater VT undercorrection for − 9.4° than did the dorsal group for − 1.2° (p < 0.001). Major complications requiring plate removal occurred in six of nine patients in the dorsal group and two of 19 patients in the volar group. The complication ratio was significantly greater in the dorsal group than in the volar group (p < 0.05). Improvements in forearm and wrist ROM, grip strength, and MMWS did not differ significantly between groups.
Opening wedge osteotomy of the radius using a volar locking plate is preferable to dorsal buttress fixation in terms of surgical and technical demands and frequency of complications, but VT correction is insufficient. Surgeons should be aware of the mismatch between the plate and the volar surface of the malunited distal radius.
KeywordsCorrective osteotomy Distal radius malunion Three dimensional Dorsal approach Volar approach Computer simulation
This work was supported by JSPS KAKENHI Grant Number JP 15K10442 and by AMED Grant Number 15570777.
Compliance with ethical standards
Each author certifies that his or her institution approved the human protocol for this investigation, all investigations were conducted in conformity with ethical principles of research, and informed consent was obtained from all study participants.ᅟ
Conflict of interest
O.K. received funding in support of this research from the Japan Society for the Promotion of Science (JSPS). T.M. received funding in support of this research from the Japan Agency for Medical Research and Development (AMED). All the other authors have no conflict of interest.
- 12.Oka K, Murase T, Moritomo H, Goto A, Sugamoto K, Yoshikawa H (2010) Corrective osteotomy using customized hydroxyapatite implants prepared by preoperative computer simulation. The international journal of medical robotics + computer assisted surgery: MRCAS 6(2):186–193. https://doi.org/10.1002/rcs.305 CrossRefPubMedGoogle Scholar
- 13.Osada D, Kamei S, Takai M, Tomizawa K, Tamai K (2007) Malunited fractures of the distal radius treated with corrective osteotomy using volar locking plate and a corticocancellous bone graft following immediate mobilisation. Hand Surg 12(3):183–190. https://doi.org/10.1142/S0218810407003560 CrossRefPubMedGoogle Scholar
- 16.Murase T, Oka K, Moritomo H, Goto A, Sugamoto K, Yoshikawa H (2009) Correction of severe wrist deformity following physeal arrest of the distal radius with the aid of a three-dimensional computer simulation. Arch Orthop Trauma Surg 129(11):1465–1471. https://doi.org/10.1007/s00402-008-0800-x CrossRefPubMedGoogle Scholar
- 17.Oka K, Moritomo H, Goto A, Sugamoto K, Yoshikawa H, Murase T (2008) Corrective osteotomy for malunited intra-articular fracture of the distal radius using a custom-made surgical guide based on three-dimensional computer simulation: case report. J Hand Surg Am 33(6):835–840. https://doi.org/10.1016/j.jhsa.2008.02.008 CrossRefPubMedGoogle Scholar
- 18.Oka K, Murase T, Moritomo H, Goto A, Sugamoto K, Yoshikawa H (2009) Accuracy analysis of three-dimensional bone surface models of the forearm constructed from multidetector computed tomography data. The international journal of medical robotics + computer assisted surgery : MRCAS 5(4):452–457. https://doi.org/10.1002/rcs.277 CrossRefPubMedGoogle Scholar
- 19.Oka K, Murase T, Moritomo H, Goto A, Nakao R, Sugamoto K, Yoshikawa H (2011) Accuracy of corrective osteotomy using a custom-designed device based on a novel computer simulation system. Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 16(1):85–92. https://doi.org/10.1007/s00776-010-0020-4 CrossRefGoogle Scholar
- 20.Omori S, Murase T, Kataoka T, Kawanishi Y, Oura K, Miyake J, Tanaka H, Yoshikawa H (2014) Three-dimensional corrective osteotomy using a patient-specific osteotomy guide and bone plate based on a computer simulation system: accuracy analysis in a cadaver study. The international journal of medical robotics + computer assisted surgery: MRCAS 10(2):196–202. https://doi.org/10.1002/rcs.1530 CrossRefPubMedGoogle Scholar
- 22.Cooney WP, Bussey R, Dobyns JH, Linscheid RL (1987) Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 214:136–147Google Scholar
- 23.Martinez-Mendez D, Lizaur-Utrilla A, de Juan-Herrero J (2018) Prospective study of comminuted articular distal radius fractures stabilized by volar plating in the elderly. Int Orthop. https://doi.org/10.1007/s00264-018-3903-1
- 24.Srinivasan RC, Jain D, Richard MJ, Leversedge FJ, Mithani SK, Ruch DS (2013) Isolated ulnar shortening osteotomy for the treatment of extra-articular distal radius malunion. The Journal of Hand Surgery 38(6):1106–1110. https://doi.org/10.1016/j.jhsa.2013.03.015
- 25.von Campe A, Nagy L, Arbab D, Dumont CE (2006) Corrective osteotomies in malunions of the distal radius: do we get what we planned? Clin Orthop Relat Res 450:179–185. https://doi.org/10.1097/01.blo.0000223994.79894.17 CrossRefGoogle Scholar