Reconstructive osteotomy for malunion of the distal radius

Common misconceptions about distal radius fractures result in undertreatment of many fractures, particularly in an active population. Loss of reduction of the fracture may cause a symptomatic malunion. Fourteen patients with an average age of 39 years (range, 21-65 years) underwent reconstructive procedures for radial malunions. The common malunion healed in a position of dorsal angulation, loss of radial inclination, and radial shortening. Ten patients had been treated by closed means, and 4 had undergone earlier surgical procedures without acceptable healing position of the fracture. Seven patients underwent a radial osteotomy alone, 5 patients had an osteotomy with an ulnar leveling procedure, and 2 patients had a Sauvé-Kapandji procedure alone. The average improvement in radial inclination was 14 degrees (range, 0 degrees-34 degrees), volar tilt 21 degrees (range, 2 degrees-33 degrees), and improvement in a positive ulnar variance by 6.8 mm (range, 0-48 mm). The complication rate was 29%, with a followup of 29 months (range, 12-43 months). Functional improvement was notable in 12 of 14 patients. Surgical reconstruction for malunions is technically difficult and may not completely restore the anatomy. Patient satisfaction, however, in terms of increased function, decreased pain, and decreased deformity is sufficiently high to warrant reconstructive treatment.