Purpose
Osteotomy of the distal radius for a fracture malunion is a challenging procedure.
The purpose of this study was to review a series of osteotomies to determine the type
and risk of complications.
Methods
A retrospective cohort study was performed, including all Kaiser Permanente Southern
California patients who were aged 18 years or older between January 1, 2007, and September
25, 2015, and underwent osteotomy for an extra-articular distal radius fracture malunion.
Charts were reviewed for demographic data, comorbidities, osteotomy type (hinged vs
distraction), implant, and bone graft type. Complications including infection, nonunion,
loss of reduction, implant failure, nerve injury, tendon injury, and complex regional
pain syndrome were recorded.
Results
There were 60 patients who underwent extra-articular osteotomy of the distal radius
for malunion during the study period. The mean age was 54 years (range, 21–83 years).
There were 24 distraction-type (intervening bone graft) and 36 hinge-type (volar cortical
contact maintained) osteotomies. Twenty-five of 60 patients had complications related
to the procedure requiring 13 subsequent procedures. There were 7 nonunions and 3
cases of delayed healing at the osteotomy site. One extensor carpi radialis longus
tendon laceration resulted from the use of an osteotome. There were 3 delayed extensor
pollicis longus (EPL) tendon ruptures after surgery. The distraction-type osteotomy
was associated with a greater risk of major complications including nonunion and delayed
union.
Conclusions
A complication rate of nearly 50% was observed in distal radius osteotomies. Surgeons
should be aware of the risk of injury to, or delayed rupture of the EPL tendon associated
with these procedures. The risk of nonunion or delayed union is higher in distraction-type
compared with hinge-type osteotomies. Low surgeon volume with this procedure may be
a contributing factor to the high rate of complications.
Type of study/level of evidence
Therapeutic IV.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Assessment of complications of distal radius fractures and development of a complication checklist.J Hand Surg Am. 2001; 26: 916-922
- Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older.J Hand Surg Am. 2014; 39: 1280-1286
- A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly.J Hand Surg Am. 2011; 36: 824-835
- Management of complications of distal radius fractures.Hand Clin. 2015; 31: 205-215
- Management of post-traumatic malunion of fractures of the distal radius.Orthop Clin North Am. 2007; 38: 203-216
- Osteotomy for extra-articular malunion of the distal radius.in: Fernandez D.L. Fractures and Injuries of the Distal Radius and Carpus. WB Saunders, Philadelphia2009: 529-541
- Clinical outcomes of corrective osteotomy for distal radial malunion: a review of opening and closing-wedge techniques.J Bone Joint Surg Am. 2011; 93: 1619-1626
- Distal radius malunion.J Hand Surg Am. 2004; 4: 266-274
- Correction of post-traumatic wrist deformity in adults by osteotomy, bone-grafting, and internal fixation.J Bone Joint Surg Am. 1982; 64: 1164-1178
- Surgical correction of dorsally angulated distal radius malunions with fixed angle volar plating: a case series.J Hand Surg Am. 2006; 31: 366-372
- Osteotomy for malunited fractures of the distal radius: a comparison of structural and nonstructural autogenous bone grafts.J Hand Surg Am. 2002; 27: 216-222
- Bone-graft substitutes: facts, fictions, and applications.J Bone Joint Surg Am. 2001; 83 (98–93)
- The role of bone allografts in the treatment of angular malunions of the distal radius.J Hand Surg Am. 2011; 36: 1804-1809
- Corrective osteotomy for volarly malunited distal radius fracture.J Hand Surg Am. 2009; 34 (33.e1): 27-33
- Corrective osteotomy for deformity of the distal radius using a volar locking plate.Hand (N Y). 2008; 3: 61-68
- A comparison of early and late reconstruction of malunited fractures of the distal end of the radius.J Bone Joint Surg Am. 1996; 78: 739-748
- Corrective osteotomies in malunions of the distal radius: do we get what we planned?.Clin Orthop Relat Res. 2006; 450: 179-185
- Corrective osteotomy for symptomatic increased ulnar tilt of the distal end of the radius.J Hand Surg Am. 2001; 26: 722-732
- Extensor pollicis longus ruptures following distal radius osteotomy through a volar approach.J Hand Surg Am. 2016; 41: 395-398
- Outcome after corrective osteotomy for malunited fractures of the distal end of the radius.J Hand Surg Am. 2002; 27: 55-60
- Immediate mobilisation following corrective osteotomy of distal radius malunions with cancellous graft and volar fixed angle plates.J Hand Surg Am. 2007; 32: 88-92
- Corrective osteotomy for malunited, volarly displaced fractures of the distal end of the radius.J Bone Joint Surg Am. 1997; 79: 1816-1826
- Management of complications of distal radius fractures.Hand Clin. 2015; 31: 205-215
- Management of malunions of the distal radius.Hand Clin. 2012; 28: 207-216
- Essential radiographic evaluation for distal radius fractures.Hand Clin. 2005; 21: 279-288
- Reconstructive procedures for malunion and traumatic arthritis.Orthop Clin North Am. 1993; 24: 341-363
- Corrective interventions in malunited fractures of the distal radius [in German].Z Unfallchir Versicherungsmed Berufskr. 1989; 82: 34-44
- A comparative study of ulnar-shortening osteotomy by the freehand technique versus the Rayhack technique.J Hand Surg Am. 2006; 31: 252-257
- Isolated ulnar shortening osteotomy for the treatment of extra-articular distal radius malunion.J Hand Surg Am. 2013; 38: 1106-1110
- Outcome analysis of ulnar shortening osteotomy for ulnar impaction syndrome.Can J Plast Surg. 2012; 20: e1-e5
- The AO ulnar shortening osteotomy system indications and surgical technique.J Wrist Surg. 2014; 3: 91-97
- Ulnar shortening osteotomy for ulnar impaction syndrome.J Wrist Surg. 2014; 3: 85-90
- The use of bone grafts and substitutes in the treatment of distal radius fractures.Hand Clin. 2012; 28: 217-223
- Bone graft substitutes.Hand Clin. 2012; 28: 457-468
- Complications of distal radius fractures.Hand Clin. 2010; 26: 85-96
- Complications of distal radial and scaphoid fracture treatment.J Bone Joint Surg Am. 2013; 95: 1517-1526
- Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal part of the radius.J Bone Joint Surg Am. 2003; 85: 1956-1960
- Flexor tendon injuries following locked volar plating of distal radius fractures.J Hand Surg Am. 2008; 33: 164-167
- Malunion of the distal radius.Arch Orthop Trauma Surg. 2012; 132: 693-702
Article info
Publication history
Published online: February 04, 2019
Accepted:
December 10,
2018
Received:
September 12,
2017
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
