OUTCOME OF DISTAL RADIUS MALUNIONS MANAGED BY CORRECTIVE OSTEOTOMY BY VOLAR APPROACH- A CLINICAL AND RADIOLOGICAL STUDY

BACKGROUND Malunion is the most common complication following distal radius fractures with a greater prevalence among lower socioeconomic status in Indian subcontinent. Pain at the wrist, decreased grip strength and decreased range of movements at the joint are the usual presenting symptoms. Malunion leads to functional limitation of affected wrist significantly hampering the activities of daily living and loss of employment. It can be treated by surgical intervention. We report the functional and radiological outcome after corrective osteotomy of malunited distal radius using volar approach and fixation with a volar locked plate. MATERIALS AND METHODS 16 malunited distal radius fractures in skeletally-matured patients were treated with an osteotomy and iliac crest corticocancellous bone graft. Corrective osteotomy with definitive fixation was done using a distal radius volar plate osteosynthesis. Outcomes were evaluated using modified Mayo wrist score and DASH questionnaire. RESULTS On radiological evaluation post operatively, radial inclination was in the range of 20.9 degrees, a volar inclination of 7.9 degrees. All osteotomies healed within acceptable limit by modified Graham’s radiographic criteria of acceptable healing of distal radius fractures. Modified Mayo wrist score assessment shows 4 excellent results, 8 having good results, 4 having satisfactory results and no poor results. The average score is 82.5 (range 65-90). DASH questionnaire. Analysis postoperatively revealed the average score is improved from preoperative mean 60.36 to 18.49. CONCLUSION Corrective osteotomy and volar plate fixation of distal radius for symptomatic malunion gives favourable radiological and functional outcome with improvements in grip strength, range of movements, pain and cosmesis