Correcting depressed distal radial malunions at distal levels via a 5 mm incision

This study aims to evaluate the efficiency of correcting depressed distal radial malunions at distal levels via a 5 mm incision.

Between May 2021 and October 2023, 46 patients (46 wrists; external fixation group) with depressed distal radial malunions at the distal levels were treated. For comparison, we reviewed another 49 patients (49 wrists; plating group) treated with conventional open reduction and internal fixation with plate and crew systems in an earlier period.

In the plating group, secondary surgery to remove the plate was performed in 32 of 49 patients. There were significant differences in off work time (152 ± 42 vs. 210 ± 72; P < 0.01) and total treatment cost and loss due to off work (US$ 32,653 ± 1,234 vs. US$ 43,653 ± 3,234; P < 0.01). There were significant between-group differences in radial height (12.1 ± 3.9 mm vs. 10.2 ± 2.7 mm; P < 0.05) and ulnar variance (0.5 ± 0.2 mm vs. 1.7 ± 1.2 mm; P < 0.05). There was no significant difference in the Mayo Wrist Scores (94.3 ± 5.7 vs. 92.8 ± 7.1; P > 0.05), including excellent (32 vs. 33), good (14 vs. 13), and fair (0 vs. 3) results. The patient aesthetics scores were 8.8 ± 1.8 vs. 8.1 ± 1.1 (P < 0.05). The patient satisfaction scores were 8.9 ± 1.6 vs. 8.1 ± 1.2 (P < 0.05) based on the Short Assessment of Patient Satisfaction questionnaire.

Depressed distal radial malunions at the distal levels can be treated via a 5 mm incision. External fixation through this small incision may be effective in maintaining radial height, especially in patients with osteoporosis. Usually, owing to a non-necessity for secondary implant removal in some patients, this technique results in acceptable outcomes in total treatment cost, total off work time, and patient satisfaction. The technique can be an alternative in addition to plate fixation. However, more factors should be considered when selecting the treatment strategy.