Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 3 Issue 11

Significance of Co-existing Distal Radio-Ulnar Joint Injuries in the Surgical Management of Distal Radius Malunion

Nikil Sanaba Paramesh* and Abhishek M Matapathi

Department of Orthopaedics, Dr. B.R. Ambedkar Medical College, Bengaluru, Rajiv Gandhi University of Health Sciences, India

*Corresponding Author: Nikil Sanaba Paramesh, Department of Orthopaedics, Dr. B.R. Ambedkar Medical College, Bengaluru, Rajiv Gandhi University of Health Sciences, India.

Received: September 11, 2020; Published: October 20, 2020

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Abstract

Background: Distal radius malunion is a major complication of distal radius fractures, reported in about 33% of cases. Corrective osteotomy to restore normal anatomy usually provides improved function and significant pain relief. We report the outcomes in a case-series with special attention to the potential influence of the initial management.

Material and Methods: This single-centre retrospective study included 15 patients, which included 11 males and 4 females, with a mean age of 32 years (range, 14-55 years). They were from different socio-economic and professional backgrounds. There were 10 extra-articular fractures, including 7 with volar angulation, 3 anterior marginal fractures, and 2 intra-articular T-shaped fractures; the dominant side was involved in 13/15 patients. Initial fracture management was with Kapandji intra-focal pinning in 3 patients, anterior plate in 3 patients, and non-operative reduction in 9 patients. The malunion was anterior in 13 patients, including 3 with intra-articular malunion, and posterior in 2 patients. Corrective osteotomy of the radius was performed in all 15 patients between 2018 June and 2019 July. Mean time from fracture to osteotomy was 145 days (range, 45-180 days). The defect was filled using an iliac bone graft in all patients. No procedures on the distal radio-ulnar joint were performed during the corrective osteotomy surgery. 2 patients among these underwent revision surgery on distal ulna on a later date.

Results: All 15 patients were evaluated 12 months after the corrective osteotomy. They showed gains in ranges not only of flexion/extension, but also of pronation/supination. All patients reported improved wrist function. The flexion/extension arc increased by 44° (+24° of flexion and +20° of extension) and the pronation/supination arc by 30° (+15° of pronation and +15° of supination). Mean visual analogue scale score for pain was 1.5 (range, 0-3). Complications recorded within 12 months after corrective osteotomy were complex regional pain syndrome type I (n = 1), radio-carpal osteoarthritis (n = 2), and restricted supination due to incongruity of the distal radio-ulnar joint surfaces (n = 2). This last abnormality should therefore receive careful attention during the management of distal radius malunion.

Discussion: In our case-series study, 2 (13.33%) patients required revision surgery for persistent loss of supination. Here we found that the reason was failure to perform an additional procedure on the distal radio-ulnar joint despite finding joint congruity on postoperative x-ray. Hence, it can be concluded that outcome of corrective osteotomy for distal radius malunion significantly depends on distal radio-ulnar joint congruity.

Keywords: Distal Radius Osteotomy; Ulanr Shortening; DRUJ Congruity; Unstable Radius Fractures; MDRF; Malunited Distal Radius Fracture

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References

  1. Nellans Kate W., et al. “The epidemiology of distal radius fractures”. Hand Clinics2 (2012): 113-125.
  2. Trumble Thomas E., et al. "Instructional course lectures, the American academy of orthopaedic surgeons - intra-articular fractures of the distal aspect of the radius*†". The Journal of Bone and Joint Surgery 80.4 (1998): 582-600.
  3. George Albert V and Jeffrey N Lawton. "Management of complications of forearm fractures". Hand Clinics2 (2015): 217-233.
  4. B J McGrory and P C Amadio. “Malunion of the distal radius”. in: Cooney WP, Linscheid RL, Dobyns JH, eds. The Wrist: Diagnosis and Operative Treatment. St Louis, MO: Mosby (1998): 356-384.
  5. Sharma, Himanshu., et al. "Outcomes and complications of fractures of distal radius (AO Type B And C): volar plating versus nonoperative treatment". Journal of Orthopaedic Science4 (2014): 537-544.
  6. Crosby Carla A., et al. "Rehabilitation Following Thumb CMC, Radiocarpal, And DRUJ Arthroplasty". Hand Clinics 1 (2013): 123-142.
  7. Degreef Ilse and Luc De Smet. “The Scheker distal radioulnar joint arthroplasty to unravel a virtually unsolvable problem”. Acta orthopaedica Belgica2 (2013): 141-145.
  8. Oka Kunihiro., et al. "A Comparison Of Corrective Osteotomies Using Dorsal And Volar Fixation For Malunited Distal Radius Fractures". International Orthopaedics12 (2018): 2873-2879.
  9. Dubert T., et al. "Le Questionnaire DASH. Adaptation Française D'un Outil D'évaluation International". Chirurgie De La Main4 (2001): 294-302.
  10. J L Knirk and J B Jupiter. "Intra-Articular Fractures Of The Distal End Of The Radius In Young Adults". The Journal of Bone and Joint Surgery5 (1986): 647-659.
  11. P Mansat., et al. "Long-Term Outcome Of Distal Ulna Resection-Stabilisation Procedures In Post-Traumatic Radio-Ulnar Joint Disorders". Orthopaedics and Traumatology: Surgery and Research3 (2010): 216-221.
  12. A I Kapandji. "Treatment Of Distal Radius Fractures By Intra-Focal Pinning With Arum Pins". Wrist Disorders (1992): 217-225.
  13. Kerboul B., et al. “Étude comparative de trois methodes therapeutiques de la fracture de Pouteau-Colles. A propos des 97 cas”. Journal de Chirurgie 123 (1986): 428-434.
  14. Lecestre P., et al. “Fractures de l’extremité inferieure du radius traitées par la methode de Kapandji. Analyse de 100 cas”. Annales de Chirurgie 42 (1988): 756-769.
  15. P Y Milliez., et al. “Influence de la mobilisation precoce après embrochage intra-focal selon Kapandji dans les fractures de l’extremité inferieure du radius. Resultats d’une étude prospective sur 60 cas”. International Orthopaedics 16 (1992): 39-43.
  16. G Herzberg and C Dumontier. “Symposium: les fractures fraiches du radius distal chez l’adulte”. Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur1 (2000): 1585-1588.
  17. L Obert., et al. “Fixation Of Distal Radius Fractures In Adults: A Review". Orthopaedics and Traumatology: Surgery and Research2 (2013): 216-234.
  18. Bronstein Andrew J., et al. "The effects of distal radius fracture malalignment on forearm rotation: a cadaveric study". The Journal of Hand Surgery2 (1997): 258-262.
  19. P Saffar and Y Tafnkji. “Cal vicieux du radius en flexion”. Chirurgie de la Main 24 (2005): 299-304.
  20. Filer J., et al. “Assessing Distal Radius Malrotation Following Fracture Using Computed Tomography". Journal of Orthopaedic Surgery3 (2019): 1-6.
  21. KJ Prommersberger., et al. “Rotational deformity in malunited fractures of the distal radius". The Journal of Hand Surgery 1 (2004): 110-115.
  22. J Van Cauwelaert and L De Smet. "Corrective Osteotomy For Malunion Of The Distal Radius In Young And Middle-Aged Patients: An Outcome Study". Chirurgie De La Main2 (2003): 84-89.
  23. B Coulet., et al. “Is Distal Ulna resection influential on outcomes of distal radius malunion corrective Osteotomies?". Orthopaedics and Traumatology: Surgery and Research5 (2011): 479-488.
  24. Gupta NR., et al. “Perioperative and long-term complications of iliac crest bone graft harvesting for spinal surgery: a quantitative review of literature”. International Medical Journal 8 (2001): 163-166.
  25. P Mathew and M G Elias. "Anterolateral Surgical Approach To The Malunited Distal Radius Fracture For Corrective Osteotomy And Bone-Graft Harvest". Techniques in Hand and Upper Extremity Surgery1 (2013): 28-34.
  26. M A Posner and L Ambrose. "Malunited Colles' Fractures: Correction With A Biplanar Closing Wedge Osteotomy". The Journal of Hand Surgery6 (1991): 1017-1026.
  27. G Sennwald., et al. “Le cal vicieux du radius distal et son traitement: à propos de 122 radius”. International Orthopaedics 16 (1992): 45-51.
  28. DR Bickerstaff and MJ Bell "Carpal Malalignment In Colles' Fractures". The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand2 (1989): 155-160.
  29. A Gupta., et al. “Carpal Alignment In Distal Radial Fractures". BMC Musculoskeletal Disorders1 (2002).
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Citation

Citation: Nikil Sanaba Paramesh and Abhishek M Matapathi. “Significance of Co-existing Distal Radio-Ulnar Joint Injuries in the Surgical Management of Distal Radius Malunion".Acta Scientific Orthopaedics 3.11 (2020): 50-57.




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