Advertisement

Z-Corrective Osteotomy in Malunited Extra-Articular Fractures of Distal Radius

Published:August 20, 2021DOI:https://doi.org/10.1016/j.jhsa.2021.06.023

      Purpose

      We sought to assess clinical, radiological, and functional outcomes following treatment of extra-articular malunions of the distal radius using a multiplanar z-corrective osteotomy.

      Methods

      Fifteen patients with extra-articular distal radius malunions (13 dorsal and 2 volar) underwent z-corrective osteotomy and volar plate fixation without bone grafting. Correction and maintenance of each deformity was evaluated in terms of various radiographic indices (radial height; volar and radial tilt); osteotomy union; pain (visual analog scale); grip strength; range of motion; Disabilities of the Arm, Shoulder, and Hand scores; and Mayo wrist scores.

      Results

      The mean follow-up was 16.4 months. The mean radial height was corrected from -1.3 mm to 4.9 mm. The mean ulnar variance improved from 4.3 mm to -0.4 mm. The sagittal radial tilt and radial inclination were restored from a mean of -17.9° (dorsal) to 3.3° (volar) and from 12.0° to 17.2°, respectively. The Disabilities of the Arm, Shoulder, and Hand and Mayo wrist scores improved from means of 36 and 56 preoperatively to 24.8 and 73.3, respectively, at 6 months and further to 20.6 and 77.6, respectively, at the last follow-up. There were no nonunions or tendon-related problems. The mean pain score decreased from 4.1 preoperatively to 1.0 at 6 months and 0.8 at the last follow-up. The mean grip strength improved from 5.6 kg preoperatively to 15.6 kg at 6 months and 19.7 kg at the last follow-up. There was a statistically significant improvement in range of motion at the wrist.

      Conclusions

      The z-osteotomy provides correction of deformity in all 3 planes, along with restoration of radial height. It also maintains a broad area of bone contact between the 2 osteotomized bone fragments, facilitating bony union and eliminating the need for bone grafting.

      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 access
      One-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 Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Brudvik C.
        • Hove L.M.
        Childhood fractures in Bergen, Norway: identifying high-risk groups and activities.
        J Pediatr Orthop. 2003; 23: 629-634
        • Abramo A.
        Flow chart for treatment: a standardized treatment program as an aid in primary treatment of distal radius fractures.
        in: Hove L.M. Lindau T. Holmer P. Distal Radius Fractures Current Concepts. Springer-Verlag, 2014: 105-108
        • Bushnell B.D.
        • Bynum D.K.
        Malunion of the distal radius.
        J Am Acad Orthop Surg. 2007; 15: 27-40
        • Pogue D.J.
        • Viegas S.F.
        • Patterson R.M.
        • et al.
        Effects of distal radius fracture malunion on wrist joint mechanics.
        J Hand Surg Am. 1990; 15: 721-727
        • Slagel B.E.
        • Luenam S.
        • Pichora D.R.
        Management of post-traumatic malunion of fractures of the distal radius.
        Hand Clin. 2010; 26: 71-84
        • McKay S.D.
        • MacDermid J.C.
        • Roth J.H.
        • Richards R.S.
        Assessment of complications of distal radius fractures and development of a complication checklist.
        J Hand Surg Am. 2001; 26: 916-922
        • Posner M.A.
        • Ambrose L.
        Malunited Colles’ fractures: correction with a biplanar closing wedge osteotomy.
        J Hand Surg Am. 1991; 16: 1017-1026
        • Sharpe F.
        • Stevanovic M.
        Extra-articular distal radial fracture malunion.
        Hand Clin. 2005; 21: 469-487
        • Fernandez D.L.
        Correction of post-traumatic wrist deformity in adults by osteotomy, bone-grafting, and internal fixation.
        J Bone Joint Surg Am. 1982; 64: 1164-1178
        • Krukhaug Y.
        • Hove L.M.
        Corrective osteotomy for malunited extra-articular fractures of the distal radius: a follow-up study of 33 patients.
        Scand J Plast Reconstr Surg Hand Surg. 2007; 41: 303-309
        • Haghverdian J.C.
        • Hsu J.Y.
        • Harness N.G.
        Complications of corrective osteotomies for extra-articular distal radius malunion.
        J Hand Surg Am. 2019; 44: 987.e1-987.e9
        • Scott R.T.
        • Berlet G.C.
        Calcaneal Z osteotomy for extra-articular correction of hindfoot valgus.
        J Foot Ankle Surg. 2013; 52: 406-408
        • Steck J.K.
        • Ringstrom J.B.
        Long Z-osteotomy: a review and new modification to correct troughing.
        J Foot Ankle Surg. 2001; 40: 305-310
        • Kohler R.
        • Walch G.
        • Noyer D.
        • Chappuis J.P.
        Posttraumatic club-hand. Therapeutic problems (apropos of 5 cases).
        Rev Chir Orthop Reparatrice Appar Mot. 1982; 68: 333-341
        • Prommersberger K.J.
        • Froehner S.C.
        • Schmitt R.R.
        • Lanz U.B.
        Rotational deformity in malunited fractures of the distal radius.
        J Hand Surg Am. 2004; 29: 110-115
        • Ladd A.L.
        • Huene D.S.
        Reconstructive osteotomy for malunion of the distal radius.
        Clin Orthop Relat Res. 1996; 327: 158-171
        • Shea K.
        • Fernandez D.L.
        • Jupiter J.B.
        • Martin Jr., C.
        Corrective osteotomy for malunited, volarly displaced fractures of the distal end of the radius.
        J Bone Joint Surg Am. 1997; 79: 1816-1826
        • Prommersberger K.J.
        • van Schoonhoven J.
        • Lanz U.B.
        Outcome after corrective osteotomy for malunited fractures of the distal end of the radius.
        J Hand Surg Br. 2002; 27: 55-60
        • Flinkkilä T.
        • Raatikainen T.
        • Kaarela O.
        • Hämäläinen M.
        Corrective osteotomy for malunion of the distal radius.
        Arch Orthop Trauma Surg. 2000; 120: 23-26
        • Hove L.M.
        • Mölster A.O.
        Surgery for posttraumatic wrist deformity. Radial osteotomy and/or ulnar shortening in 16 Colles’ fractures.
        Acta Orthop Scand. 1994; 65: 434-438
        • Thivaios G.C.
        • McKee M.D.
        Sliding osteotomy for deformity correction following malunion of volarly displaced distal radial fractures.
        J Orthop Trauma. 2003; 17: 326-333
        • Wada T.
        • Isogai S.
        • Kanaya K.
        • Tsukahara T.
        • Yamashita T.
        Simultaneous radial closing wedge and ulnar shortening osteotomies for distal radius malunion.
        J Hand Surg Am. 2004; 29: 264-272
        • Wada T.
        • Tatebe M.
        • Ozasa Y.
        • et al.
        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
        • Tang J.B.
        • Ryu J.
        • Omokawa S.
        • Han J.
        • Kish V.
        Biomechanical evaluation of wrist motor tendons after fractures of the distal radius.
        J Hand Surg Am. 1999; 24: 121-132
        • Adams B.D.
        Effects of radial deformity on distal radioulnar joint mechanics.
        J Hand Surg Am. 1993; 18: 492-498
        • Tarallo L.
        • Mugnai R.
        • Adani R.
        • Catani F.
        Malunited extra-articular distal radius fractures: corrective osteotomies using volar locking plate.
        J Orthop Traumatol. 2014; 15: 285-290
        • Peterson B.
        • Gajendran V.
        • Szabo R.M.
        Corrective osteotomy for deformity of the distal radius using a volar locking plate.
        Hand (N Y). 2008; 3: 61-68
        • Franchignoni F.
        • Vercelli S.
        • Giordano A.
        • Sartorio F.
        • Bravini E.
        • Ferriero G.
        Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH).
        J Orthop Sports Phys Ther. 2014; 44: 30-39