Background: Corrective osteotomy is an appealing treatment for
malunited articular fractures of the distal part of the radius since articular
incongruity may be the factor most strongly associated with arthrosis and
diminished function after such fractures. Enthusiasm for osteotomy has been
limited by concerns regarding the difficulty of the technique and the
potential for additional injury, osteonecrosis, and nonunion.
Methods: Twenty-three skeletally mature patients were evaluated at
an average of thirty-eight months after corrective osteotomy for an
intra-articular malunion of the distal part of the radius. The indication for
the osteotomy included dorsal or volar subluxation of the radiocarpal joint in
fourteen patients and articular incongruity of =2 mm as measured on a
posteroanterior radiograph in seventeen patients. Six patients had combined
intra-articular and extra-articular malunion. The average interval from the
injury to the osteotomy was six months. The average maximum step-off or gap of
the articular surface prior to the operation was 4 mm.
Results: One patient had a subsequent partial wrist arthrodesis
because of radiocarpal arthrosis, and three patients had additional surgery
because of dysfunction of the distal radioulnar joint. One patient had a
rupture of the extensor pollicis longus, which was treated with a tendon
transfer. The final articular incongruity averaged 0.4 mm, and the final grip
strength averaged 85% of that on the contralateral side. The rate of excellent
or good results was 83% according to the rating systems of Fernandez and of
Gartland and Werley, and 43% according to a modification of the rating system
of Green and O'Brien.
Conclusions: The results of corrective osteotomy for the treatment
of intra-articular malunion are comparable with those of osteotomy for the
treatment of extra-articular malunion. Intra-articular osteotomy can be
performed with acceptable safety and efficacy, it improves wrist function, and
it may help to limit the need for salvage procedures such as partial or total
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.