DISTAL RADIAL OSTEOTOMY FOR MALUNION OF WRIST FRACTURES IN YOUNG PATIENTS

Malunion after a fracture of the distal radius in a young patient causes a significant disturbance of wrist function. We have performed distal radial osteotomies in 11 patients to correct radial malunion. Surgery was indicated in young patients with functional disability in the wrist due to limited wrist motion and pain. Many had an unacceptable cosmetic appearance of the wrist. In all patients surgery consisted of opening wedge osteotomies to correct radial tilt and radial angle. In some instances it was not possible completely to restore radial length without a reduction in ulnar length. Post-operatively combined dorsal and volar flexion improved from a mean of 34 ” to 72”. Combined pronation and supination improved from a mean of 68 ” to 106”. Pain assessed on a simple four-point functional score was decreased from a mean of 3.3 to 1.3. Journal of Hand Surgery (British and European Volume, 1994) 19B: 5: 589-593 Fractures of the distal radius occur as a result of varying degrees of violence depending on the age of the patient. In young patients a high degree of violence is required to produce fractures and they are usually of a different pattern than those more commonly seen in elderly osteoporotic women. The high energy injuries in the young often result in severely comminuted intraarticular fractures (Melone, 1986). As with all intraarticular fractures in young people, anatomical reduction should be the goal to achieve the best possible outcome with regard to function and prevention of degenerative changes. Unfortunately, fractures of the distal radius have traditionally been described as Colles ’ or Smiths ’ frac-tures, and as such have been thought of and treated in the same manner in the young as in the elderly, in whom it is a pathological fracture. Treatment has been stan-dardized and conservative treatment rCgimes are com-monly practiced which lead to malunion in the young if reduction is incomplete or is subsequently lost. Open wedge linear radial osteotomy with bone grafting to correct the malunion of fractures of the distal radius has been described before (Campbell, 1937; Fernandez