[The Malunited Distal Radius Fracture - Extraarticular Correction without Bone Graft]

In open wedge osteotomies of the distal radius, bone grafts increase initial stability and enhance bone formation but are frequently associated with complaints and complications at the donor site. Previous studies have suggested that bone grafting may probably be unnecessary.

Between 2013 and 2016, 19 patients with symptomatic extra-articular fractures of the distal radius, malunited in extension, underwent corrective osteotomy using a palmar locking implant without an additional bone graft. 3 patients dropped out for implant related problems. One patient refused the follow-up investigation.

12 patients (7 male / 5 female) showed complete remodeling of the defect at 5.5 ± 3.5 (1.5-13) months. Palmar tilt improved significantly, from a mean of 17° to -1°, the DASH score from 41 ± 26 (7-94) points to 26 ± 25 (0-75). Radial inclination and ulnar variance and pain level showed only slight, non-significant improvement. Final range of motion and grip strength did not improve. In the modified Mayo wrist score, 5 excellent, 1 good, 3 fair and 3 unfavourable results were obtained. Three female patients showed no remodeling at 10 ± 3 (6-12) months. In the modified Mayo wrist score, 1 fair and two unfavourable results were obtained. One of these patients underwent reoperation with iliac crest bone grafting. Though remodeling of the distal radius only failed in female patients, no statistically significant dependence of bony healing on gender, age at the date surgery or size of the defect was found. In the healed group there was no statistical correlation between the interval from surgery to bony fusion and gender, age at the date of surgery or width of the osteotomy gap dorsally. A correlation was found between the widths of the osteotomy gap palmarly and the interval to bony fusion.

After open wedge osteotomy of the distal radius, remodeling may occur without filling the defect by a bone graft. Since bony healing is not predictable and may require more than 12 months in single cases, we will continue bone grafting in our own practice.