Acta Orthopaedica, 79(2), 262–268
Background and purpose: Malunion after a distal radius fracture can be treated with an osteotomy of the distal radius. Often autologous iliac crest bone graft is used to fill the gap, but this is associated with donor site morbidity. Instead of bone graft, we have used a slow-resorbing bone substitute in combination with minimally invasive fixation technique.
Patients and methods: 25 consecutive patients with a dorsla malunion after a distal radius fracture underwent an osteotomy. A TriMed buttress pin and a radial pin plate were used for for fixation, and Norian SRS as bone substitute. The patients were followed for a minimum of 1 year and range of motion, grip strenght, DASH scores, and the radiographic correction were measured.
Results: Forearm rotation improved from 137* to 155*, flexion/extension from 102* to 120*, and radioulnar deviation from 32* to 43*. Grip strenght increased from 62% of the contralateral hand to 82%. DASH scores decreased from 36 to 23. Radiographically, all osteotomies but 1 healed and the radiographic correciotn achieved was consistent over the first year.
Interpretation: Osetotomy of the distal radius is effective in increasing motion and grip strenght after a malunited distal radial fracture. Patient satisfaction is high and subjective results measured with DASH are good. Using a bone substitute, the operation can be performed as an outpatient procedure and donor-sire pain avoided. No loss of the radiographic correction achieved was noted during osteotomy healing.