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Corrective osteotomy of malunited distal radius fractures using bone allografts and internal fixation with locking plates

By Nadine Hollevoet and Wim Vanhove

Abstract

Objective: Symptomatic extra-articular malunion of a distal radius fracture can be treated with a corrective osteotomy. Usually autogenous iliac bone grafts or synthetic bone substitutes are used to fill the gap. Other options are bone allografts or leaving the gap empty. The purpose of the present study was to investigate whether correction can be maintained with allografts and internal fixation with locking plates. Methods: Between March 2006 and February 2014, we perforemd 26 corrective osteotomies of the distal radius, using frozen bone allografts. There were 21 women and five men, mean age 50 years (range, 18-78). Palmar locing plates were used in 17 patients and dorsal plates with locking screws were used in nine. Palmar tilt and ulnar variance were measured on wrist radiographs preoperatively, 1 day postoperatively, and after bone healing. Results: The osteotomy healed, with integration of the bone allograft, in all patients. Mean preoperative ulnar variance measured 5 mm (range, 0 to 10) and mean palmar tilt was 4° range, -28 to 39). On the first postoperative radiographs, the mean ulnar variance measured + 1 mm (range, -11 to 25). After bone healing, mean ulnar variance measured 2 mm (range, -1 to 5) and mean palmar tilt 11° (range, -6 tot 25). When the first postoperative radiographs were compared with those after bone healing, we found an increase in ulnar variance of > 1 mm in one-third of the patients. In one case, palmar tilt change was > 10°. Conclusion: a stable fixation can be obtained with locking plates and bone allografts, but a small increase in ulnar variance can be expected

Topics: Medicine and Health Sciences
Year: 2015
OAI identifier: oai:archive.ugent.be:6883809
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