Corrective osteotomy of a malunion of the distal radius using a spanning plate in an older patient

Distal radius malunions in older patients represent a therapeutic challenge due to osteoporotic bone quality and the need to preserve autonomy. Spanning plates, which are widely used in complex distal radius fractures, allow immediate weight-bearing, but their use in corrective osteotomies has not been reported.

We report the case of a 77-year-old right-handed female patient, dependent on a cane, who presented with a distal radius malunion 3 months after conservative management of a displaced fracture. The deformity resulted in severe functional impairment and loss of independence. Considering her frailty and scheduled tibiotalar arthrodesis, a corrective osteotomy of the distal radius with an autologous bone graft and fixation using a dorsal spanning plate was performed during the same procedure. This strategy allowed for the patients to use a cane immediately after the procedure. Rehabilitation was initiated early, leading to full recovery of finger flexion within 11 days. Five months after plate removal, the patient presented 50 ° flexion, 50 ° extension, and a grip strength of 12 kg; showed complete pain resolution; and had a QuickDASH score of 18.18.

This case highlights the potential use of spanning plates as a temporary fixation method for distal radius corrective osteotomy in frail older patients. This technique allows weight-bearing immediately after surgery, thus preserving autonomy while providing satisfactory functional and radiological outcomes.