Corrective Osteotomy for Volarly Malunited Distal Radius Fracture

Kazuki Satou, Toshiyasu Nakamura, Takuji Iwamoto, Yoshiaki Toyama, Hiroyasu Ikegami, Shinichiro Takayama

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Purpose: To retrospectively analyze consecutive cases with opening wedge corrective osteotomy of the volarly malunited distal radius with iliac bone graft, including preoperative and postoperative comparison of symptoms, visual analog scale (VAS), Japanese Society for Surgery of the Hand version of the Disabilities of the Arm, Shoulder, and Hand (DASH-JSSH) questionnaires, radiographic indices, clinical results as evaluated by modified Mayo wrist score, and complications. Methods: Subjects were 28 patients with volarly malunited distal radius fracture treated by transverse opening wedge osteotomy with oblique iliac bone graft. Preoperative symptoms included wrist deformity, weakness of grip strength, and marked restriction of supination range. Postoperative symptoms, radiographic parameters, clinical results, and complications were analyzed at an average of 25 months of follow-up. We also analyzed the union period of the radius in younger patients (≤45 years old) and older patients (>45 years old). Results: Mean preoperative visual analog scale was 45, improving significantly to 3 postoperatively. Range of wrist motion improved in all 28 patients, with supination range improving from 16° preoperatively to 80° postoperatively. Mean preoperative DASH-JSSH score was 55, improving to 9 postoperatively. Radiography revealed that volar tilt improved from 32° preoperatively to 10° postoperatively, and radial inclination increased from 17° to 21°. Preoperative ulnar variance of +5.9 mm was corrected to -0.1 mm postoperatively. All 28 wrists demonstrated bony union at the osteotomy site after an average of 52 days (younger patients, 51 days; older patients, 54 days). No complications, significant radiographic correction loss, or nonunion were seen after at least 2 years of follow-up. Modified Mayo wrist score was excellent in 16 patients, good in 10 patients, and fair in 2 patients. Conclusions: Opening wedge osteotomy for volarly malunited distal radius fracture restored bony configuration of the distal radius, decreased pain, and improved grip strength and range of wrist motion, particularly for forearm supination. No complications or noteworthy correction loss were noted after surgery, even in older patients. Type of study/level of evidence: Therapeutic IV.

Original languageEnglish
JournalJournal of Hand Surgery
Volume34
Issue number1
DOIs
Publication statusPublished - 2009 Jan

Fingerprint

Radius Fractures
Osteotomy
Wrist
Supination
Hand Strength
Articular Range of Motion
Visual Analog Scale
Hand
Transplants
Bone and Bones
Forearm
Radiography
Arm

Keywords

  • Distal radius
  • malunion
  • opening wedge osteotomy
  • Smith's fracture
  • volar angulation

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Corrective Osteotomy for Volarly Malunited Distal Radius Fracture. / Satou, Kazuki; Nakamura, Toshiyasu; Iwamoto, Takuji; Toyama, Yoshiaki; Ikegami, Hiroyasu; Takayama, Shinichiro.

In: Journal of Hand Surgery, Vol. 34, No. 1, 01.2009.

Research output: Contribution to journalArticle

Satou, Kazuki ; Nakamura, Toshiyasu ; Iwamoto, Takuji ; Toyama, Yoshiaki ; Ikegami, Hiroyasu ; Takayama, Shinichiro. / Corrective Osteotomy for Volarly Malunited Distal Radius Fracture. In: Journal of Hand Surgery. 2009 ; Vol. 34, No. 1.
@article{a741a6169add401aaf91bee898f9e087,
title = "Corrective Osteotomy for Volarly Malunited Distal Radius Fracture",
abstract = "Purpose: To retrospectively analyze consecutive cases with opening wedge corrective osteotomy of the volarly malunited distal radius with iliac bone graft, including preoperative and postoperative comparison of symptoms, visual analog scale (VAS), Japanese Society for Surgery of the Hand version of the Disabilities of the Arm, Shoulder, and Hand (DASH-JSSH) questionnaires, radiographic indices, clinical results as evaluated by modified Mayo wrist score, and complications. Methods: Subjects were 28 patients with volarly malunited distal radius fracture treated by transverse opening wedge osteotomy with oblique iliac bone graft. Preoperative symptoms included wrist deformity, weakness of grip strength, and marked restriction of supination range. Postoperative symptoms, radiographic parameters, clinical results, and complications were analyzed at an average of 25 months of follow-up. We also analyzed the union period of the radius in younger patients (≤45 years old) and older patients (>45 years old). Results: Mean preoperative visual analog scale was 45, improving significantly to 3 postoperatively. Range of wrist motion improved in all 28 patients, with supination range improving from 16° preoperatively to 80° postoperatively. Mean preoperative DASH-JSSH score was 55, improving to 9 postoperatively. Radiography revealed that volar tilt improved from 32° preoperatively to 10° postoperatively, and radial inclination increased from 17° to 21°. Preoperative ulnar variance of +5.9 mm was corrected to -0.1 mm postoperatively. All 28 wrists demonstrated bony union at the osteotomy site after an average of 52 days (younger patients, 51 days; older patients, 54 days). No complications, significant radiographic correction loss, or nonunion were seen after at least 2 years of follow-up. Modified Mayo wrist score was excellent in 16 patients, good in 10 patients, and fair in 2 patients. Conclusions: Opening wedge osteotomy for volarly malunited distal radius fracture restored bony configuration of the distal radius, decreased pain, and improved grip strength and range of wrist motion, particularly for forearm supination. No complications or noteworthy correction loss were noted after surgery, even in older patients. Type of study/level of evidence: Therapeutic IV.",
keywords = "Distal radius, malunion, opening wedge osteotomy, Smith's fracture, volar angulation",
author = "Kazuki Satou and Toshiyasu Nakamura and Takuji Iwamoto and Yoshiaki Toyama and Hiroyasu Ikegami and Shinichiro Takayama",
year = "2009",
month = "1",
doi = "10.1016/j.jhsa.2008.09.018",
language = "English",
volume = "34",
journal = "Journal of Hand Surgery",
issn = "0363-5023",
publisher = "W.B. Saunders Ltd",
number = "1",

}

TY - JOUR

T1 - Corrective Osteotomy for Volarly Malunited Distal Radius Fracture

AU - Satou, Kazuki

AU - Nakamura, Toshiyasu

AU - Iwamoto, Takuji

AU - Toyama, Yoshiaki

AU - Ikegami, Hiroyasu

AU - Takayama, Shinichiro

PY - 2009/1

Y1 - 2009/1

N2 - Purpose: To retrospectively analyze consecutive cases with opening wedge corrective osteotomy of the volarly malunited distal radius with iliac bone graft, including preoperative and postoperative comparison of symptoms, visual analog scale (VAS), Japanese Society for Surgery of the Hand version of the Disabilities of the Arm, Shoulder, and Hand (DASH-JSSH) questionnaires, radiographic indices, clinical results as evaluated by modified Mayo wrist score, and complications. Methods: Subjects were 28 patients with volarly malunited distal radius fracture treated by transverse opening wedge osteotomy with oblique iliac bone graft. Preoperative symptoms included wrist deformity, weakness of grip strength, and marked restriction of supination range. Postoperative symptoms, radiographic parameters, clinical results, and complications were analyzed at an average of 25 months of follow-up. We also analyzed the union period of the radius in younger patients (≤45 years old) and older patients (>45 years old). Results: Mean preoperative visual analog scale was 45, improving significantly to 3 postoperatively. Range of wrist motion improved in all 28 patients, with supination range improving from 16° preoperatively to 80° postoperatively. Mean preoperative DASH-JSSH score was 55, improving to 9 postoperatively. Radiography revealed that volar tilt improved from 32° preoperatively to 10° postoperatively, and radial inclination increased from 17° to 21°. Preoperative ulnar variance of +5.9 mm was corrected to -0.1 mm postoperatively. All 28 wrists demonstrated bony union at the osteotomy site after an average of 52 days (younger patients, 51 days; older patients, 54 days). No complications, significant radiographic correction loss, or nonunion were seen after at least 2 years of follow-up. Modified Mayo wrist score was excellent in 16 patients, good in 10 patients, and fair in 2 patients. Conclusions: Opening wedge osteotomy for volarly malunited distal radius fracture restored bony configuration of the distal radius, decreased pain, and improved grip strength and range of wrist motion, particularly for forearm supination. No complications or noteworthy correction loss were noted after surgery, even in older patients. Type of study/level of evidence: Therapeutic IV.

AB - Purpose: To retrospectively analyze consecutive cases with opening wedge corrective osteotomy of the volarly malunited distal radius with iliac bone graft, including preoperative and postoperative comparison of symptoms, visual analog scale (VAS), Japanese Society for Surgery of the Hand version of the Disabilities of the Arm, Shoulder, and Hand (DASH-JSSH) questionnaires, radiographic indices, clinical results as evaluated by modified Mayo wrist score, and complications. Methods: Subjects were 28 patients with volarly malunited distal radius fracture treated by transverse opening wedge osteotomy with oblique iliac bone graft. Preoperative symptoms included wrist deformity, weakness of grip strength, and marked restriction of supination range. Postoperative symptoms, radiographic parameters, clinical results, and complications were analyzed at an average of 25 months of follow-up. We also analyzed the union period of the radius in younger patients (≤45 years old) and older patients (>45 years old). Results: Mean preoperative visual analog scale was 45, improving significantly to 3 postoperatively. Range of wrist motion improved in all 28 patients, with supination range improving from 16° preoperatively to 80° postoperatively. Mean preoperative DASH-JSSH score was 55, improving to 9 postoperatively. Radiography revealed that volar tilt improved from 32° preoperatively to 10° postoperatively, and radial inclination increased from 17° to 21°. Preoperative ulnar variance of +5.9 mm was corrected to -0.1 mm postoperatively. All 28 wrists demonstrated bony union at the osteotomy site after an average of 52 days (younger patients, 51 days; older patients, 54 days). No complications, significant radiographic correction loss, or nonunion were seen after at least 2 years of follow-up. Modified Mayo wrist score was excellent in 16 patients, good in 10 patients, and fair in 2 patients. Conclusions: Opening wedge osteotomy for volarly malunited distal radius fracture restored bony configuration of the distal radius, decreased pain, and improved grip strength and range of wrist motion, particularly for forearm supination. No complications or noteworthy correction loss were noted after surgery, even in older patients. Type of study/level of evidence: Therapeutic IV.

KW - Distal radius

KW - malunion

KW - opening wedge osteotomy

KW - Smith's fracture

KW - volar angulation

UR - http://www.scopus.com/inward/record.url?scp=58149089005&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=58149089005&partnerID=8YFLogxK

U2 - 10.1016/j.jhsa.2008.09.018

DO - 10.1016/j.jhsa.2008.09.018

M3 - Article

VL - 34

JO - Journal of Hand Surgery

JF - Journal of Hand Surgery

SN - 0363-5023

IS - 1

ER -