Radius Corrective Osteotomy
Despite increasing improvements in the treatment of distal radius fractures and the advancement in operative techniques, malpositioning following the healing of distal radius fractures remains a common complication. Unsuccessful conservative therapy, secondary loss of correction after surgical treatment, and malpositioned radius fracture fixation are the main causes.
Examination and Diagnosis
During their consultation with a hand surgeon, patients often report deformation of the wrist joint with what is known as a dinner fork or bayonet deformity; this is when the ulna is visibly too long compared to the radius. This results in pain and a reduced range of pronation and supination movement coupled with loss of strength. Often this is also accompanied by an articular disc injury. The x-ray and CT images usually show a shortened and malpositioned radius on the extensor side (dorsal angulation) or flexor side (palmar angulation).
Conservative therapy for a badly healed radius fracture only makes sense if the patient has no symptoms. However, in the long term, without corrective measures, arthrosis of the wrist can be expected to develop.
The aim of corrective surgery is the anatomical restoration of the radiocarpal joint surface and the distal radioulnar joint with an adequate matching of the lengths of the radius and ulna. For malpositioning with shortening of only the radius, the ulna can be shortened (ulnar shortening osteotomy). When coupled with radial malpositioning, corrective osteotomy of the radius should be carried out. Where possible, these procedures should be performed as quickly as possible following the diagnosis of malpositioning. These procedures are accomplished on an inpatient basis with a stay of between 3 and 5 days. In some cases, a wrist arthroscopy will be carried out to determine the status of the cartilage. The incision is normally made on the flexor side of the wrist (radiopalmar). The radius is sawed through, the position is corrected and the wrist is fixed with a stable-locking plate made from titanium and titanium screws. In many cases, a bone graft is collected from the iliac crest to ensure that the radius heals better (known as a spongioplasty). After the operation, the arm is fitted with a plaster cast covering the wrist and lower arm.
Finger physiotherapy begins on the first day after the operation. An x-ray evaluation takes place a day later. After the swelling has subsided, a hand therapist will fit a thermoplastic splint. Splint immobilisation is required for approx. 4 weeks. The suture material is removed after 12 to 14 days. After the splint is removed, another x-ray evaluation will be carried out and further hand therapy initiated. In the long term, after the radius have healed (confirmed via CT), we recommend the removal of the osteosynthesis material (stable-locking plate), as this plate can have disruptive effects on the certain everyday activities.