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Ulnar Shortening Osteotomy versus Corrective Radius Osteotomy after Distal Radius Malunion
Ali Izadpanah, MSc, MD, FRCSC1; William Aibinder, MD2; Bassem T. Elhassan, MD2 1McGill University Health Centre, Montreal, QC, Canada; 2Mayo Clinic, Rochester, MN.

Introduction: Distal radius fractures are the most common fractures of the upper extremity representing up to 3% of all upper extremity injuries. Only few studies report on the functional outcomes after ulnar shortening procedures for treating distal radius malunions.
Methods: A retrospective review of 11 patients with extra-articular distal radius malunion treated with ulnar shortening osteotomy (USO) was performed with an average of 12.713.2 months was performed. An age matched group of 11 patients after distal radius osteotomy (DRO) was randomly selected and compared.
Results: The average age of patients undergoing USO was 52.3 and DRO 53.8. Average ulnar shortening was 4.9 mm (mean 4.3 mm ulnar positive variance preoperatively in USO group). Average preoperative flexion and extension had improved from 46.7 and 44.6 to 50.4 and 53.2 postoperatively for USO, respectively (p>0.05). Patients undergoing DRO had a statistically significant increase in flexion and extension from 41.9 to 51.2 and 41.1 to 53.4, respectively (p<0.05). Pronation had worsened in USO group from an average of 66.0 to 57.0, whereas supination improved from 45 to 52 (p>0.05). DRO group had an improvement in supination and pronation from 59.1 and 54.2 to 65.4 and 65.3, respectively. Ulnar and radial deviations had increased from 25 to 28 and decreased from 17 to 15 for USO, respectively (p>0.05). In comparison, DRO group had an increase in both ulnar and radial deviations from 21 to 30 and 15.6 to 18.5, respectively (p>0.05). The grip and pinch strengths had increased from 14.4 kg to 23.3 kg for USO and from 14.1 kg to 22.3 kg for DRO, respectively. The average VAS had improved from 5.1 and 5.4 to 2.0 and 1.95 for USO and DRO, respectively (p<0.05). The final ulnar variance after USO was -1.9 mm versus 0.8 mm for DRO. Two patient underwent USO after DRO for persistent impaction symptoms. The total tourniquet time was slightly lower in USO group (97.3 minutes) compared to DRO (116 minutes).
Conclusion: Significant improvement of motion, grip strength, and VAS for both groups occured. Patients with matched age group, symptoms, and radiological findings with positive volar tilt and radial inclination more than 15 undergoing DRO had a greater improvement in grip strength and range of motion at wrist and forearm compared to USO after surgery. Nevertheless, USO being a simpler procedure with a shorter operative time can be an attractive alternative with acceptable outcomes to address distal radius malunions.

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