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Corrective Radial and Ulnar Osteotomies for Distal Radial Fracture Malunion
Takuro Wada1, Masahiro Tatebe2, Yasuhiro Ozasa1
1Department of Orthopaedic Surgery, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan. E-mail address for T. Wada: twada@sapmed.ac.jp. E-mail address for Y. Ozasa: ozasa.yasuhiro@mayo.edu. E-mail address for T. Yamashita: tyamasit@sapmed.ac.jp.
Introduction:
We describe a technique consisting of simultaneous radial closing-wedge and ulnar shortening osteotomy to treat malunion of distal radial fractures.
Step 1 Preoperative Planning:
Plan the radial closing-wedge osteotomy to correct the volar tilt angle to 8.5° to 15.5° and the ulnar shortening osteotomy to restore ulnar variance to -2.5 to 0.5 mm.
Step 2 Radial Closing-Wedge Osteotomy:
Remove the wedge of bone from the radius and reduce the distal fragment, keeping the dorsal cortex as a hinge.
Step 3 Distal Ulnar Shortening Osteotomy:
Resect the section of the ulna equivalent to the positive ulnar variance with transverse osteotomies.
Step 4 Plate Fixation Of The Radial Osteotomy Site:
Hold together the two fragments of the radius with a Kirschner wire and fix the osteotomy site with a volar locking plate.
Step 5 Proximal Ulnar Shortening Osteotomy:
Evaluate residual ulnar positive variance with fluoroscopy and restore the ulnar variance to within a normal range by removing additional bone from the proximal fragment.
Step 6 Plate Fixation Of The Ulnar Osteotomy Site:
Use a compression device to close and fix the ulnar osteotomy site.
Step 7 Postoperative Management:
Allow early motion immediately after the operation.
Results:
We retrospectively evaluated forty-two patients at a minimum of one year after treatment of an extra-articular distal radial malunion with a radial corrective osteotomy.
What To Watch For:
IndicationsContraindicationsPitfalls & Challenges.
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