Corrective Osteotomy for Malunited Extra-articular Fractures of the Distal Radius: a Follow-up Study of 33 Patients

We present a series of 33 consecutive patients treated with lengthening osteotomy due to malunited extra-articular fractures of the distal radius. Thirty-one patients were able for long-term follow-up a median (range) of seven (2-20) years after the procedure. The indication for reconstruction was mainly impaired function of the wrist. Both the anatomy and function were improved significantly postoperatively. The median radial length improved 5 mm, the radial tilt 25 degrees, and the radial inclination improved 9 degrees. The median improvement of forearm supination was 20 degrees, pronation 10 degrees, dorsal wrist flexion 10 degrees, and volar flexion 20 degrees. Twenty-two of 29 patients (76%) rated the functional results as good or excellent. The functional results were significantly better postoperatively, but the results were still better on the uninjured side. The grip strength on the operated hand was 82% of the uninjured hand, and the median postoperative DASH-score was 21. In five patients the graft resorbed (one fracture of the plate) and needed reoperation. All eventually healed and the anatomical and functional results were good. Another patient had symptomatic osteoarthrosis and later had a full wrist fusion. We conclude that every effort should be made to prevent malunion in the treatment of distal radius fractures, becauseeven after anatomical correction, function is not restored fully in all patients.