AAHS Annual Meeting
Back to main AAHS site
Annual Meeting Home
Final Program
2016 Annual Meeting Photos
Past & Future Meetings

Back to 2016 Annual Meeting Program

Orthogonal Plating with Corrective Osteotomy for Treatment of Distal Radius Fracture Malunion
Michael P. Gaspar, MD; Jenniefer Y. Kho, MD; Patrick M. Kane, MD; Randall W. Culp, MD
Thomas Jefferson University, Philadelphia Hand Center, Philadelphia, PA

Introduction: Substandard treatment of distal radius fractures (DRF) often results in malunions which typically have significantly debilitating effects on patients, including pain and loss of motion. The purpose of this study is to describe our institution's experience with corrective osteotomy of DRF malunions and other DR deformities, using orthogonal volar and radial plating.

Methods: We retrospectively reviewed the charts of all patients who underwent corrective osteotomy of the distal radius by one senior, fellowship-trained hand surgeons (RWC) from 2007 through 2014 using orthogonal ("90/90") plate fixation. Demographic data, injury history, prior treatment(s) and clinical exam values were recorded. Bivariate statistical analysis with independent t-test was utilized for comparison of pre- and post-operative wrist and forearm range of motion and grip strength. Secondary outcomes of complications and/or need for revision surgery were also recorded.

Results: Thirty-seven wrists in 37 (24 female, 13 male) patients satisfied inclusion in this study. Average age of all patients included was 53.0 +/- 12.3 years. Aside from two patients treated for Madelung's deformity, all other patients had sustained a prior fracture, of which 15 had been operated on previously, and 20 were initially treated non-operatively. Volar tilt was initially present in 8 patients (35.3 +/- 17.3 deg), with the remainder of patients presenting with dorsal tilt (26.5+/- 12.3 deg). Twenty surgeries were performed on the non-dominant extremity. The mean interval from initial injury or prior intervention to surgery was 14.4 +/- 24.6 months. Significant improvement was seen in flexion/extension arc (86.6 +/- 25.4 deg pre-operatively vs. 102.3 +/- 24.9 deg post-operatively; p = 0.016) and grip strength measured by dynamometer (36.8 +/- 27.6 pre-operatively vs. 57.7 +/- 25.4 post-operatively; p = 0.005). No significant difference was observed between pre- and post-operative forearm rotation. Thirteen patients underwent a subsequent operation at mean 8.5 +/- 9.7 months from the index 90/90 fixation procedure: five patients had one or both plates removed due to symptomatic hardware, four patients underwent ulnar shortening osteotomies for persistent ulnar-sided wrist pain, two patients had tenolysis for tendon adhesions, two had revision carpal tunnel releases and two patients had irrigation and debridement with wound closure for persistent drainage, though no signs of overt infection were noted.

Conclusions: Orthogonal plating in conjunction with corrective osteotomy of distal radius malunions or deformities is an effective treatment option for added stability of the radial column and allows for improved motion, with acceptably low rate of revisions.

Back to 2016 Annual Meeting Program
© 2020 American Association for Hand Surgery. Privacy Policy.