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
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Article info
Publication history
Published online: August 20, 2021
Accepted:
June 30,
2021
Received:
April 16,
2020
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
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
