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Radiocarpal and Midcarpal Joint Malalignment with Distal Radius Malunion and Factors in Correction after Osteotomy
Michael Doarn, MD; Youssef Hedroug, BS; John Fernandez, MD; Mark Cohen, MD; Robert Wysocki, MD
Midwest Orthopaedics at Rush, Chicago, IL

Purpose: To evaluate the radiocarapal and midcarpal joints of the hand after treatment of distal radius malunion with corrective osteotomy and to evaluate if initial severity of injury and timing to osteotomy correlate with radiographic outcomes.

Methods: A retrospective review of all patients treated with a corrective osteotomy for distal radius dorsal bending malunion was performed. Data collected included patient demographics, pre-operative and post-operative radiographs, post-operative range of motion, and any complications or secondary procedures.

Results: Seventy-four patients were treated with a distal radius osteotomy from 2006-2015. Sixteen patients underwent osteotomy for other reasons and were not included. Fifty-nine fractures in 58 patients required osteotomy with plate fixation for a malunion subsequent to a distal radius bending fracture. Fourteen patients that had previous surgery, 5 that were skeletally immature, 6 that did not meet minimum follow-up requirements, 1 that had incomplete records, and 6 that had a volar bending distal radius fracture were excluded. Twenty-seven radii in 26 patients with a mean age of 54 (19-79) years were included for final analysis. Mean follow-up of patients was 38 (12-170) weeks. Twenty-five were right-hand-dominant and 15 had an injury to the right arm. Twenty-five patients sustained injury via a fall. The mean time from initial injury to distal radius corrective osteotomy was 49 (3-303) weeks. Mean time to union after corrective osteotomy was 15 (4-61) weeks. Mean correction of radial height 4.9 mm (3.9 mm to 8.8 mm), inclination 10.2o (11.60 to 21.8o), ulnar variance 2.3 mm (3.9 mm to 1.6 mm positive), and tilt 23.6o (23.1o dorsal to 0.47o volar) (P<0.0001). Mean correction of radiolunate angle 9.3o (17.5o to 8.2o), radioscaphoid angle 7.2o (48.1o to 55.3o), and effective radiolunate flexion (ERLF) 13.4o (20.9o to 7.5o) (P<0.0001). Mean correction of capitolunate angle 2.4o (9o to 11.4o) (P<0.11). Initial severity of injury correlated with ability to correct ERLF (P=0.04). Time from initial injury to corrective osteotomy correlated with ability to correct the radiolunate angle (P=0.01). It was more difficult to correct the radiolunate angle with increased time from injury to osteotomy, especially beyond 40 weeks (P=0.06). Post-operative ERLF was more difficult to correct for the radiocarapl malalignment pattern versus the midcarpal pattern (P=0.001).

Conclusions: Severity of initial fracture and time from injury to corrective osteotomy correlates with ability to correct radiographic parameters. Early correction of distal radius malunions is thus recommended, especially in patients with radiocarpal malalignment patterns.

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