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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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.

Copyright

Copyright: © 2020 Nikil Sanaba Paramesh and Abhishek M Matapathi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.