American Association for Hand Surgery
Theme: Beyond Innovation

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Corrective Osteotomy for Distal Radius Malunion: Complication Rates and Risk Factors
Kevin T Rezzadeh, BA1; Sara M Glynn, CPA2; Louis W Catalano, MD3; Steven Z Glickel, MD1; Jacques H. Hacquebord, MD1
1New York University School of Medicine, New York, NY, 2CV Starr Hand Surgery Center, New York, NY, 3New York University Hospital for Joint Diseasses, New York, NY

HYPOTHESIS
The complication rate for distal radius malunion corrective osteotomy and risk factors for postoperative complications have not been well studied. In this study, we examine the complication rate for corrective surgery and attempt to identify associated risk factors. We hypothesize that corrective osteotomy for distal radius fracture malunion has a high complication rate (>15%), and that older age, female gender, dorsal surgical approach, and the use of bone grafting are associated with greater rate of postoperative complications.
METHODS
A retrospective review of all adult patients (>18 years of age) who underwent distal radius corrective osteotomy (CPT 25350) from 2010-2017 was performed. Patient demographics, comorbidities, and perioperative variables were collected. Perioperative variables included: surgical approach, bone graft use, and type of bone graft. Only major complications were considered in this analysis. Major complications required operative management for resolution and included hardware removal, revision osteotomy, nonunion, tendon rupture/adhesions, and ligament repair. Binary logistic regression was used to determine whether age, gender, surgical approach, or time between fracture and operation were risk factors for higher complication rates. Exclusion criteria were age under 18, distal radius fracture < 4 weeks before surgery, and less than three months of follow-up after surgery.
RESULTS
A total of 59 patients were included. Information regarding patient demographics and comorbidities were collected. Patients had an average of 14.8 months (SD:39.4) between their distal radius fracture and surgery. The volar approach with volar plating was used for 66.0% of the corrective osteotomies. Bone grafting was used in 72.9% of cases. The leading causes of major complications included symptomatic hardware (8.5%), tendon adhesion/rupture requiring operation (6.8%), and nonunion (5.1%). Using binary logistic regression, no significant risk factors were found for the incidence of major complications.
SUMMARY
This is the largest study to date with the primary goal to determine complication rates of corrective osteotomy for distal radius malunion. Corrective osteotomy has a high rate of major complication 22.0% in the current study. Age, gender, time between fracture and operation, dorsal surgical approach, and the use of bone grafting were not significant risk factors for complications. Further investigation and analysis needs to be performed to better characterize postoperative complications and associated risk factors.


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