Secondary procedures following a distal radius fracture

Introduction : Relatively few patients with a malunited distal radius fracture need a corrective osteotomy or salvage procedure. The purpose of the study was to find specific radiological features in wrists of patients who had an additional operation in comparison with patients with malunion without secondary surgical intervention. Patients and methods : Wrist X-rays of 63 malunited distal radius fractures (sustained between May 2008 and June 2010) without additional surgery and X-rays of 42 patients who needed an additional surgical procedure at least 3 months following a distal radius fracture were compared. Eighty-five percent of secondary operations occurred within two years following the distal radius fracture. X-ray measurements included radial inclination, ulnar variance, palmar tilt, intra-articular steps and radiocarpal alignment. Difference between the groups in age, gender and radiological parameters was analysed with the Mann-Whitney U or the Chi- square test. Results : Mean age of patients without additional surgery was 59 and of those with secondary procedures 47 years. The difference was significant. There was no significant difference in gender and radiological parameters between the two groups. Mean palmar tilt was 2° without surgery and 0° with secondary surgery. In both groups mean radial inclination measured 22° and mean ulnar variance 2 mm. Intra-articular steps were present in 19 patients without secondary surgery and in 14 with additional operations. Normal carpal alignment was present in 58 % of wrists without additional surgery and in 44% of wrists with secondary procedures. Conclusion Patients who underwent a corrective osteotomy or salvage procedure following a distal radius fracture were younger than those with malunion who did not have additional surgery. Radiological parameters were similar in both groups