Simultaneous radial closing wedge and ulnar shortening osteotomy for distal radius malunion

Closing wedge osteotomies are an attractive treatment option for distal radius malunion in patients with osteopenia. It does not require a separate-site bone graft, result-ing in decreased morbidity. However, this procedure has always been performed in combination with ulnar head resection to accommodate closure of corrective osteotomy and to address the issue of ulnocarpal abutment. Because ulnar shortening osteotomy is more physiological solution, it seemed advantageous to us to combine radial closing wedge osteotomy and ulnar shortening osteotomy. In this article, we present in detail our technique for treating patients with distal radius malunion. The patients are potentially osteopenic such as women aged over 45 years and are active at home, work, and/or recreation but are not involved in heavy physical work. Through volar approach an appropriate bone wedge is removed from the distal radius. A small volar T-plate is used to secure the osteotomized bone fragments. The aim of the radial osteotomy is to correct the dorsal angulation in the sagittal plane within a normal range of 1 degree to 2 degrees with reference to that of opposite wrist. Ulnar shortening osteotomy is performed by using transverse osteotomy and compression plating technique with an AO compression device. The ulnar variance is adjusted to neutral. Although the technique presented requires the surgeons to use careful plate and screw technique, early results have been encouraging, and patients with osteopenia can be treated successfully. Decreased grip strength which may be provoked by shorting of the forearm is acceptable.