Extra-articular Malunion of the Radius; Osteotomy of the Radius

Abstract

The most common radial deformity includes loss of palmar tilt, loss of inclination, loss of radial length, and a supination deformity of the distal fragment relative to the proximal diaphysis. In addition, the distal fragment may be displaced in a radial or ulnar translation and in a dorsal or palmar shift.

Operative treatment is appropriate when the radiographic deformity correlates with a specific and anatomically correctable problem and if the deformity is associated with a substantial risk of dysfunction.

The indication for operative correction is based on the combined appreciation of functional wrist impairment, the severity of pain, the grip strength, the degree of cosmetic deformity, and the radiographic findings.

The planning of angular, rotational, and length corrections are based on preoperative radiographs of both wrists.

Because radial shortening is a constant component of the deformity in both dorsal and volar malunion, an opening wedge osteotomy is recommended. This osteotomy should be transverse in the frontal plane and oblique (i.e. parallel to the joint surface) in the sagittal plane.

In nascent malunion the intention is to “take down” the maturing callus and the “osteotomy” is performed at the site of the original fracture. After removing the callus, the fracture site is exposed, and the “osteotomy” may be performed with the knife or a small chisel into the fracture line.