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Corrective Osteotomy for Intra-Articular Malunion of the Distal Part of the Radius
David Ring, MD1; Karl-Josef Prommersberger, MD2; Juan González del Pino, MD, PhD3; Miguel Capomassi, MD4; Miguel Slullitel, MD4; Jesse B. Jupiter, MD1
1 Massachusetts General Hospital, Yawkee Center, Suite 2100, 55 Fruit Street, Boston, MA 02114. E-mail address for D. Ring: dring@partners.org
2 Klinik fur Handchirurgie, Salzburger Leite 1, D97615 Bad Neustadt, Germany
3 Division of Hand Surgery, Virgen de la Torre Hospital, C/ Puerto de Lumbreras 5, 28031 Madrid, Spain
4 Instituto de Ortopedia y Traumatología Jaime Slullitel, Sanatorio de la Mujer, Rosario, Argentina
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Investigation performed at the Massachusetts General Hospital, Boston, Massachusetts; the Klinik fur Handchirurgie, Bad Neustadt, Germany; the Servicio de Cirugia de la Mano, Hospital Virgen de la Torre, Madrid, Spain; and the Trauma Center at the Instituto Jaime Slullitel, Rosario, Argentina

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Jul 01;87(7):1503-1509. doi: 10.2106/JBJS.D.02465
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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 wrist arthrodesis.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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