[The malunited distal radius fracture - early or late correction?]

BACKGROUND/GOAL: Despite the fact that corrective osteotomy for malunited distal radius fractures is widely accepted, the optimal timing is still a matter of controversy. The presented study compares the clinical and radiological results of early vs. late corrective osteotomy at the distal radius to evaluate the influence of timing.

We prospectively studied 34 consecutive patients with extraarticular malaligned fractures of the distal end of the radius who underwent corrective osteotomy. Early correction was performed in 14 patients (10 -women and 4 men with an average age of 48±18 years) at an average of 8±3 weeks (range, 3-13) after the injury, late correction in 20 patients (16 women and 4 men, average age of 54±19 years) at an average of 52±46 weeks (range, 24-229) -after the injury. The demographic data of the groups were statistically identical. Preoperatively and at the recent follow-up the range of motion of the wrist (ROM) and grip strength were recorded as well as pain at rest and activity (visual analogue scale), DASH score and radiological data. A conclusive evaluation was performed by the modified Mayo wrist score for the recent follow-up after 24±10 (6-44) (early correction) vs. 21±10 (8-56) (late correction) months.

All osteotomies healed uneventfully. Early corrections required significantly less bone-grafting. The comparison of the pre- and postoperative data in the early corrrection group showed an improvement of all parameters, that was significant in four parameters. The comparison of the pre- and postoperative data in the late correction group showed an improvement of all parameters, that was significant in 5 parameters. The comparison of the postoperative data revealed nearly identical results in both groups for all parameters including the modified Mayo wrist score.

The general improvement stresses the value of both, early and late reconstruction. Although no statistical difference was detectable early corrective osteotomy seems to be recommendable in early presenting patients, in order to avoid bone-grafting. In later presenting cases we recommend observation and return after 6 months in the case of persistent pain or disability. Nevertheless, the time choice of corrective osteotomy remains an individual decision in all patients.