Distal radius fracture is the most common fracture, approximately 25% of all fractures seen at an emergency department 1 and constitutes 17% of all the fractures and 75% of all forearm fractures. Surgical correction of malunited fractures of the distal radius. In many cases, when a fracture heals in a position that interferes with use of the involved limb, surgery can be performed to correct it. Major complications of distal radius fractures include carpal instability, distal radioulnar joint injury, complex regional pain syndrome crps, tendon rupture, ulnarsided wrist pain and malunion. Pdf fractures of distal radius account for up to 20% of all fractures treated in emergency department.
We report the outcomes in a caseseries with special attention to the potential influence of the initial management. Arthroscopic resection arthroplasty for malunited intra. Threedimensional virtual planning of corrective osteotomies. Complications of distal radius fracture fixation may arise from the injury or method of treatment, as well as both. Patient ages ranged from 17 to 68 years average, 53 y. Pdf corrective osteotomy for malunited, volarly displaced. Corrective osteotomy using a volar locking plate has recently become an alternative technique. Treatment for forearm fractures is almost always operative, but nonoperative management can be used. Dimensional in vivo analysis of malunited distal radius. Relatively longer ulna is present after distal radius fracture healed in shortened position pain at end range of pronation ulnar deviation.
Apr 30, 2019 malunited distal radius fractures drfs occasionally restrict forearm rotation, but the underlying pathology remains unclear. Pdf osteotomy of dorsally displaced malunited fractures of. Approximately 25% of distal radius fractures treated by closed means heal with deformities that exceed general parameters of acceptance dorsal tilt of 20 degrees in the sagittal plane and 10 degrees in the coronal plane, fractures are. Malunion is a major complication of fractures involving the distal radius and ulna 3, seen in up to 33% of cases 4. Sep 24, 2017 dr vikas gupta malunited distal radius fractures olwa 2018 duration. Surgical technique of corrective osteotomy for malunited. Although closed reduction with cast treatment of distal radius fractures continues to. The overall complication rate of distal radius fractures ranges from 6% to 80% and has been associated with poor functional outcomes. In the other hand, unstable fracture easily becomes malunited with inadequate treatment. Appendicular division, napa valley college, fall 2014, mr. Fracture malunion orthopaedic surgery michigan medicine. The malunited distal radius fracture early or late.
Best approaches in distal radius fracture malunions. Operative treatment is therefore mainly based on patients symptoms, 10 and once indicated, early intervention is advised. Opening wedge osteotomy for volarly malunited distal radius fracture restored bony configuration of the distal radius, decreased pain, and improved grip strength and range of wrist motion. Osteotomy for extraarticular malunion of the distal radius. Minimal malunion of the distal radius may be asymptomatic or cause mild to moderate clinical problems. Distal radius malunion is a major complication of distal radius fractures, reported in 0 to 33% of cases. The head of radius stays still and stable you can see the distal joint has considerable excersion when go from supination to pronation. Osteotomy of distal radius fracture malunion using a. Threedimensional virtual planning of corrective osteotomies of. Malunion of distal radius fractures is a frequently seen complication, occurring in. Distal radius fractures scott wolfe md upper extremity surgeon. Jul 15, 2014 in the other hand, unstable fracture easily becomes malunited with inadequate treatment. Distal radius fractures are the most common fractures in the upper extremity. From june 2007 to december 2010, 10 patients 6 females and 4 males presented to the senior author f.
Pdf relationship between distal radius fracture malunion and arm. Distal radius fractures account for 75% of all forearm fractures. Current trends in the management of distal radius fractures. The conventional corrective osteotomy for malunited distal radius fracture that employs dorsal approach and insertion of a trapezoidal bone graft does not always lead to precise correction or result in a satisfactory surgical outcome. Although abraham colles is credited as the father figure and progenitor of distal radius fracture recognition and management, the french physician, jl petit, first suggested in 1705 that posttraumatic deformity of the wrist may not be due to dislocation as was commonly thought, but was actually caused by fracture. Distal radius malunion is a major complication of distal radius fractures. The objective findings and subjective complaints of a symptomatic malunion have come to be better appreciated as patients of all ages have demand ed high levels of function after this common injury. The malunited distal radius fracture early or late correction. Treatment of neglected malunion of the distal radius. New perspectives on treatment of both bone forearm malunions article in current orthopaedic practice 255.
This attempted to eliminate any symptoms present from other. Malunion is a recognized cause of suboptimal function after distal radius fracture. Is bone grafting necessary in the treatment of malunited. Article in handchirurgie mikrochirurgie plastische chirurgie 451. Human anatomy, 8th edition, 2015, by martini, timmons, tallitsch, chapter 7, skeletal system. Despite this heterogeneity, we chose to combine all patients in one cohort. Pdf osteotomy of dorsally displaced malunited fractures. Pdf distal radius fracture is a common injury and may result in substantial dysfunction and pain. Fractures of the distal radius are common and frequently encountered by the radiologist. Correction of nascent malunion of distal radius fractures. Scientificarticle sigmoidnotchreconstructionandlimitedcarpal. Pdf corrective osteotomies in malunited distal radius. Interosseous membrane transmits forces at wrist to the key bones radius, key bone to ulna etc. Salient qualitative and quantitative features of the distal radius fracture identifiable on the routine radiography series are highlighted.
The objective findings and subjective complaints of a symptomatic malunion. Pdf rotational deformity in malunited fractures of the. Early correction of malunion of distal radius fractures may be necessary in young, active patients. In the healed distal radius fracture, the discrepancy from actual alignment to anatomic alignment is malunion. We reconstructed the malunited distal radioulnar joint by osteotomy and repositioning the displaced sigmoid notch fragments through a combined dorsal and volar approach. Orthopedics primary radial head excision for treat ment of difficult radial head and neck fractures has been considered a reasonable treatment option for many years, however, multiple. Distal radius malunion is a major complication of distal radius fractures, reported in. Unsurprisingly, distal radial fractures are the most common fracture in humans. Background open wedge osteotomy with bone grafting and plate fixation is the standard procedure for the correction of malunited distal radius fractures. Management of malunions of the distal radius request pdf. While the malunion rate in surgically treated distal radius fractures is 10%, with conservative methods the rate of malunion increased to 23. Keywords 3dimensional corrective osteotomy distal radius malunion introduction malunion of distal radius fractures is a frequently seen complication, occurring in approximately 5% of distal radius fractures 1.
Malunion remains a common complication in the treatment of distal radius fractures. The management of unstable distal radial fractures in the superelderly. New perspectives on treatment of both bone forearm malunions. Ulna and radius fractures forearm fractures johns hopkins. We present the case of a young patient with a severely comminuted, malunited, intraarticular distal radius fracture and complete disruption of the sigmoid notch. One of the major complications following fractures of the distal end of the radius is malunion 2. No loss of radiographic correction during healing with a minimally invasive fixation technique and an injectable bone substitute. Feb 17, 2014 distal radius fractures are the most common fractures in the upper extremity. Corrective osteotomies in malunited distal radius fractures. A forearm fracture can occur in one or both of the forearm bones.
Distal radius fractures are among the most common skeletal injuries, accounting for 14% of all fractures. May 25, 2017 current trends in the management of distal radius fractures. Bone grafts are used to increase structural stability and to enhance new bone formation. Corrective osteotomy of distal radius malunionnew horizons. Up to 83% of malunited distal radius fractures are symptomatic, causing pain, weakness or functional impairment of the joint. The most common deformity following a malunited extraarticular fracture of the distal radius is the loss of the normal palmar tilt of the articular surface in the sagittal plane, and loss of length relative to the ulna. Opening wedge osteotomy for distal radius malunion. To present an insideout osteotomy technique under arthroscopic guidance to correct an intraarticular malunion. Mechanical characteristics of locking and compression plate.
Osteotomy of dorsally displaced malunited fractures of the distal radius. The aim of this study was to report the advantages and disadvantages of early correction of distal radius malunion. Surgical correction of malunited fractures of the distal. Best approaches in distal radius fracture malunions ncbi. Correction of malunited intraarticular distal radius fractures with an insideout osteotomy technique. Corrective osteotomy to restore normal anatomy usually provides improved function and significant pain relief. Eight fractures were of the dominant wrist and 2 were of the nondominant wrist. Feb 07, 2018 ulnar positive variance longer distal ulna than distal radius.
In 1814, the irish surgeon abraham colles described his eponymous fracture. Pa and lateral of a malunited distal radius fracture with some loss of radial height and inclination with significant dorsal tilt and adaptive disi deformity while malunion can result in multiple changes in mechanics and may ultimately lead to arthrosis, the decision to perform a corrective osteotomy for a distal radius malunion should generally be based on the patients overall functional capacity and symptoms. The principles of treatment for distal radius fractures should be the same as for any other intraarticular or periarticular fracture. Mar 07, 2019 pa and lateral of a malunited distal radius fracture with some loss of radial height and inclination with significant dorsal tilt and adaptive disi deformity while malunion can result in multiple changes in mechanics and may ultimately lead to arthrosis, the decision to perform a corrective osteotomy for a distal radius malunion should generally be based on the patients overall functional capacity and symptoms. Dr vikas gupta malunited distal radius fractures olwa 2018 duration. The aim of this study was to report the advantages and disadvantages of early correction of.
Carpal instability, malunion among complications of distal. Up to 83% of malunited distal radius fractures are symptomatic. Corrective osteotomy for malunited, volarly displaced fractures of the distal end of the radius. The forearm is made up of two bones, the ulna and the radius. Fractures of the distal radius are among the most common fractures treated by orthopedic surgeons. Malunion causes pain, deformity, motion range limitation, and loss of strength. Malunion of the distal radius usually occurs following conservative treatment. Management of posttraumatic malunion of fractures of the. We aimed to elucidate the mechanism of rotational restriction by retrospective analysis of 23 patients with unilateral malunited drfs who presented restricted forearm rotation. Some of the causes include falls on the forearm or outstretched arm and direct impact from an object to the forearm. Pdf correction of malunited intraarticular distal radius. Do young patients with malunited fractures of the distal.