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Opening Wedge Osteotomy to Salvage Distal Radius Fractures after a Failed Volar Marginal Fragment
Jorge Luis Orbay, MD1; Michael Mijares, MD2; Cecilia Berriz, MD1; Lauren Vernon, PhD1
1The Miami Hand and Upper Extremity Institute, Miami, FL; 2University of Miami/Jackson Memorial Hospital, Miami, FL

Introduction: Articular fractures of the distal radius may include a small fragment from the volar margin of the lunate fossa (VMF). While rare, this pattern of comminution carries a worse prognosis. After open reduction and internal fixation (ORIF) of the distal radius fracture, the VMF may require additional fixation. Failure to do so may result in loss of reduction and volar carpal subluxation. When this occurs, salvage is difficult. We present our experience using a radial opening wedge osteotomy to reorient the articular surface and restore joint stability.
Methods: We retrospectively reviewed the records of all patients treated at our facility with a volar opening wedge osteotomy for the management of a collapsed VMF after volar plating a distal radius fracture. Medical charts, x-rays and therapy notes were investigated and all patients were contacted for a final evaluation. The charts were examined for the presence of complications and for functional results. The surgical procedure consisted of a volar opening wedge osteotomy in order to decrease volar tilt, restore radial length and provide volar support to the carpus. Autologous bone graft was used in all cases.
Results: We treated three patients, all female, (ages 47-70) 2-5 months post-ORIF with this indication. Cast immobilization failed to prevent progression in the cases treated with this technique, and patients presented before the third month post op with either failure of initial reduction or poor progress after the initial surgical treatment. Symptoms included unexpected pain and failure to recover forearm supination. Radiologic findings progressed from collapse of the volar marginal fragment to volar subluxation of the carpus and reabsorption of the VMF. All three patients underwent a radial opening wedge osteotomy with proximal ulna cancellous autograft. Within two months post-osteotomy all three patients had improved pain and motion. Follow-up X-rays revealed concentric joint reduction alignment. At final follow-up, patientís passive and active VAS scores were 0; their QuickDASH scores were 4.5-6.8.
Conclusion: A volar opening wedge osteotomy can be used to salvage a distal radius fracture with a collapsed volar marginal fragment while preserving the radio-carpal joint.

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