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Corrective Osteotomy for Malunited, Volarly Displaced Fractures of the Distal End of the Radius*

SHEA, KEVIN M.D.†, BOSTON; FERNANDEZ, DIEGO L. M.D.‡, AARAU, SWITZERLAND; JUPITER, JESSE B. M.D.§; MARTIN, CLAUDE JR. M.D.§, BOSTON, MASSACHUSETTS

Journal of Bone & Joint Surgery - American Volume: December 1997 - Volume 79 - Issue 12 - p 1816–26
Article

Twenty-five patients who had had an opening-wedge osteotomy for the treatment of a malunited, volarly displaced fracture of the distal end of the radius were studied retrospectively. The indications for the operation were pain and functional limitations rather than the degree of anatomical deformity. Fifteen patients were men and ten were women; their average age was forty-six years (range, twenty-one to eighty-four years). Preoperative radiographs revealed an average ulnar inclination of 14 degrees, an average ulnar variance of five millimeters, and an average volar inclination of 24 degrees. Extension of the wrist averaged 25 degrees; flexion of the wrist, 53 degrees; supination of the forearm, 41 degrees; and pronation of the forearm, 64 degrees. The average grip strength was a force of seventeen kilograms compared with a force of forty kilograms in the contralateral hand. At an average of sixty-one months (range, eighteen to 114 months) after the osteotomy, supination of the forearm had improved to an average of 69 degrees and pronation had improved to an average of 75 degrees (p < 0.05 for both). Extension of the wrist had improved to an average of 55 degrees, and grip strength had improved to a force of thirty kilograms (p < 0.05 for both). Volar inclination averaged 5 degrees; ulnar variance, zero millimeters; and ulnar inclination, 22 degrees. A reoperation was performed in eleven patients. Seven patients had removal of the hardware only, two had a procedure involving the distal radioulnar joint, one had a procedure because the site of the osteotomy had not healed, and one had a median-nerve release. The functional result was rated as very good in ten patients, good in eight, fair in three, and poor in four.

†Department of Orthopaedic Surgery, University of Utah, 50 North Medical Drive, Salt Lake City, Utah 84132. The e-mail address is kshea74283@aol.com.

‡Orthopaedische Chirurgie F. M. H., Mittelstrasse 54, CH 3012 Bern, Switzerland.

§Orthopaedic Hand Service, Massachusetts General Hospital, WACC 527, 15 Parkman Street, Boston, Massachusetts 02114. The e-mail address for Dr. Jupiter is jupiter@al.mgh.harvard.edu.

Copyright 1997 by The Journal of Bone and Joint Surgery, Incorporated
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