Arthroscopic-Assisted Osteotomy for Intraarticular Malunion of the Distal Radius

  • Francisco del PiñalEmail author


Classically, the management of the young patient with a step-off in the distal radius has been panarthrodesis. Several pioneer surgeons such as Saffar, Fernández, and others [1, 12, 14, 18–21, 23] opened the door to the possibility of cutting the displaced fragments again and reducing them in an anatomical position. The gold standard for the most common sagittal step-off (anteroposterior) is to carry out the osteotomy through a dorsal route partly under fluoroscopic guidance [1, 14, 19, 20]. For the volar shearing-type malunions, the joint is approached volarly, the external callus removed, and with an osteotome directed toward the joint, the fragment is slowly cut away with the hope that the osteotome follows the original fracture line [19, 20, 23]. All these procedures and others can be grouped under “outside-in osteotomy” techniques, and although good results have been reported, fears of devascularization and inaccurate reduction exist. Fernández [12] considers the technique appropriate only for single line fractures, González del Pino and others [14, 20] used it for the more complex four-part fracture configurations.


Distal Radius Distal Radius Fracture Extensor Tendon Radial Styloid Displace Fragment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Apergis E. Proceedings of the Ninth Congress of the International federation of Societies for Surgery of the Hand. Budapest, Hungary; 2004Google Scholar
  2. 2.
    del Piñal F. Arthroscopic assisted osteotomy for intra-articular malunions of the distal radius. In: Slutsky DJ, Osterman AL, editors. Fractures and injuries of the distal radius and carpus. Philadelphia: Saunders; 2009. p. 543–50Google Scholar
  3. 3.
    del Piñal F. Reconstruction of the distal radius facet by a free vascularized osteochondral autograft. In: Slutsky DJ, Osterman AL. editors. Fractures and injuries of the distal radius and carpus. Philadelphia: Saunders; 2009.
  4. 4.
    del Piñal F, Garcia-Bernal FJ, Delgado J, Sanmartin M, Regalado J. Results of osteotomy, open reduction, and internal fixation for late-presenting malunited intra-articular fractures of the base of the middle phalanx. J Hand Surg. 2005;30A:1039–950Google Scholar
  5. 5.
    del Piñal F, García-Bernal FJ, Delgado J, Sanmartín M, Regalado J. Reconstruction of the distal radius facet by a free vascularized osteochondral autograft: anatomic study and report of a patient. J Hand Surg. 2005;30A:1200–10Google Scholar
  6. 6.
    del Piñal F, García-Bernal FJ, Delgado J, Sanmartín M, Regalado J, Cerezal L. Correction of malunited intra-articular distal radius fractures with an inside-out osteotomy technique. J Hand Surg. 2006;31A:1029–234Google Scholar
  7. 7.
    del Piñal F, García-Bernal FJ, Pisani D, Regalado J, Ayala H, Studer A. Dry arthroscopy of the wrist: surgical technique. J Hand Surg. 2007;32A:119–23Google Scholar
  8. 8.
    del Piñal F, Cagigal L, Garcia-Bernal FJ, Studer A. Regalado J, Thams C. Arthroscopic assisted osteotomy for management of intra-articular distal radius malunions. J Hand Surg. 2010;35A:392–7Google Scholar
  9. 9.
    del Piñal F, Innocenti M. Evolving concepts in the management of the bone gap in the upper limb. Long and small defects. J Plast Reconstr Aesthet Surg. 2007;60:776–92CrossRefPubMedGoogle Scholar
  10. 10.
    Doi K, Hattori Y, Otsuka K, Abe Y, Yamamoto H. Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation. J Bone Joint Surg. 1999; 81A:1093–110Google Scholar
  11. 11.
    Edwards CC II, Haraszti CJ, McGillivary GR, Gutow AP. Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction. J Hand Surg. 2001;26A:1036–41Google Scholar
  12. 12.
    Fernandez DL. Reconstructive procedures for malunion and traumatic arthritis. Orthop Clin North Am. 1993;24:341–63PubMedGoogle Scholar
  13. 13.
    Garcia-Elias M, Lluch A, Ferreres A, Papini-Zorli I, Rahimtoola ZO. Treatment of radiocarpal degenerative osteoarthritis by radioscapholunate arthrodesis and distal scaphoidectomy. J Hand Surg. 2005;30A:8–15Google Scholar
  14. 14.
    González del Pino J, Nagy L, González Hernandez E, Bartolome del Valle E. Osteotomías intraarticulares complejas del radio por fractura. Indicaciones y técnica quirúrgica. Rev Ortop Traumatol. 2000;44:406–17Google Scholar
  15. 15.
    Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg. 1986; 68A:647–59Google Scholar
  16. 16.
    Levy HJ, Glickel SZ. Arthroscopic assisted internal fixation of volar intraarticular wrist fractures. Arthroscopy. 1993;9: 122–4CrossRefPubMedGoogle Scholar
  17. 17.
    Lutsky K, Boyer MI, Steffen JA, Goldfarb CA. Arthroscopic assessment of intra-articular distal radius fractures after open reduction and internal fixation from a volar approach. J Hand Surg. 2008;33A:476–84Google Scholar
  18. 18.
    Marx RG, Axelrod TS. Intraarticular osteotomy of distal radius malunions. Clin Orthop. 1996;327:152–7CrossRefPubMedGoogle Scholar
  19. 19.
    Prommersberger KJ, Ring D, Del Pino JG, Capomassi M, Slullitel M, Jupiter JB. Corrective osteotomy for intra-articular malunion of the distal part of the radius. Surgical technique. J Bone Joint Surg. 2006;88A(Suppl 1 Pt 2): 202–11CrossRefGoogle Scholar
  20. 20.
    Ring D, Prommersberger KJ, González del Pino J, Capomassi M, Slullitel M, Jupiter JB. Corrective osteotomy for malunited articular fractures of the distal radius. J Bone Joint Surg. 2005;87A:1503–9CrossRefGoogle Scholar
  21. 21.
    Saffar P. Treatment of distal radial intra-articular mal-unions. In: Saffar Ph, Cooney WPIII, editors. Fractures of the distal radius. London: Martin Dunitz; 1995. p. 249–58Google Scholar
  22. 22.
    Slutsky DJ. Clinical applications of volar portals in wrist arthroscopy. Tech Hand Up Extrem Surg. 2004;8: 229–38CrossRefPubMedGoogle Scholar
  23. 23.
    Thivaios GC, McKee MD. Sliding osteotomy for deformity correction following malunion of volarly displaced distal radial fractures. J Orthop Trauma. 2003;17:326–33CrossRefPubMedGoogle Scholar
  24. 24.
    Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg. 1994;19A:325–40Google Scholar
  25. 25.
    Wagner WF Jr, Tencer AF, Kiser P, Trumble TE. Effects of intra-articular distal radius depression on wrist joint contact characteristics. J Hand Surg. 1996;21A:554–660Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Head of Hand and Plastic SurgeryPrivate practice and Hospital Mutua MontañesaSantanderSpain

Personalised recommendations