The goal of this study was to assess bone healing and secondary fracture displacement in the treatment of malunited distal radius fractures without the use of bone grafting. The objective findings and subjective complaints of a symptomatic malunion have come to be better appreciated as patients of all ages have demand ed high levels of function after this common injury. A recent prospective study on the national incidence of osteoporosisassociated fractures in a population of more than 200,000 inhabitants revealed drfs as the most frequent fracture type with an annual incidence of 197100,000. Corrective osteotomy for volarly malunited distal radius fracture.
Radial corrective osteotomy can restore congruity in the distal radioulnar joint druj as well as adequate length of the radius. Up to 83% of malunited distal radius fractures are symptomatic, causing pain, weakness or functional impairment of the joint. Six months after a conservatively treated distal radius fracture the mean arc of flexion and extension and the forearm rotation were know to be 75% to 97% and 87 to 97%, respectively, compared with the uninjured side 610. The prospective populationbased cohort study included 143 consecutive patients above 18 years with an acute distal radius fracture treated with closed reduction and either cast 55. Fractures of the distal radius in postmenopausal women may cause prolonged pain and disability, but little is known about their natural course beyond. Keywords 3dimensional corrective osteotomy distal radius malunion introduction malunion of distal radius fractures is a frequently seen complication, occurring in approximately 5% of distal radius fractures 1. Acute dislocations of the distal radioulnar joint and distal ulna fractures brian t. Best approaches in distal radius fracture malunions ncbi. These common fractures usually occur when significant force is applied to the distal radial metaphysis. Distal radius fractures common injury fractures of the distal radius represent approximately 16% of all fractures treated by orthopaedic surgeons three main peaks of fracture distribution.
In younger people, these fractures typically occur during sports or a motor vehicle collision. Fractures of the distal radius are extremely common injuries, which are steadily becoming a public health issue. The higher energy of the trauma and the older the patient, the. B,normal radiocarpal and intercarpal alignment in the sagittal plane. Pa and lateral of a malunited distal radius fracture with some loss of radial height and inclination with significant dorsal tilt and adaptive disi deformity while malunion can result in multiple changes in mechanics and may ultimately lead to arthrosis, the decision to perform a corrective osteotomy for a distal radius malunion should generally be based on the patients overall functional capacity and symptoms.
The articles prior to january 20 are part of the back file collection and are not available with a current paid subscription. Jul 15, 2014 malunion of the distal radius usually occurs following conservative treatment. Corrective osteotomy for malunited fractures of the distal. However, there is no current consensual evidence to guide the selection of one technique over the other. This distal radius fracture eventually developed into a malunion. A less invasive distal osteotomy of the radius for malunited dorsally displaced extraarticular fractures. Nov 22, 20 the treatment of ulnarsided wrist pain after malunited distal radius fractures remains controversial. Treatment of malunited fractures of the distal radius. Jul 15, 2015 dorsally displaced distal radius fractures dddrf are frequent injuries in clinical practice. Distal radius malunion is a major complication of distal radius fractures, reported in 0 to 33% of cases. Metaanalysis for dorsally displaced distal radius fracture.
Malunion of the distal radius usually occurs following conservative treatment. Current concepts in the treatment of distal radial fractures. The malunited distal radius fracture early or late. Malunion causes pain, deformity, motion range limitation, and loss of strength. Evidence based postoperative treatment of distal radius. Painful elbow and had a problem lifting heavy objects. Target wire and template the distal apex of the template should be positioned 24 mm proximal to the subchondral surface of the distal radius, between listers tubercle and the center of the lunate facet so that the implant will support the loads in the wrist. The distal part of the anterior henry approach involves exposure between the flexor carpi radialis and radial artery. Corrective osteotomy of malunited fractures of the distal end of the radius. Symptoms include pain, bruising, and rapidonset swelling. Pdf malunited extraarticular distal radius fractures. One of the most common complications following distal radius fractures is still malunion of the distal radius. Oct 01, 20 current concepts in the treatment of distal radial fractures. Ekenstam f, hagert cg, engkvist o, tornvall ah, wilbrand h.
He had problems performing his work as contract worker doing tiles. A 32years old man was admitted to our departement because of severely malunited left distal radius extraarticular metaphyseal fracture after treatment of an open fracture. Suboptimal treatment of distal radius fractures may lead to malunion with the patient experiencing pain, deformity, and loss of motion. Corrective osteotomy of malunited distal radius fractures. Pdf background multiple techniques for corrective osteotomy have been developed in recent years with the same aims. Fractures of the distal radius are the most common of the upper. Kgopyane v road accident fund 432352014 2016 zagpphc. Pdf the most common complication after distal radius fractures is union with deformity. Effect of malunited fractured distal end of radius. Fractures of the distal radius occurring in young adults are treated increasingly by open surgical techniques, partly because of concern that failure to restore the alignment of the fracture accurately may cause symptomatic posttraumatic osteoarthritis in future years.
Anatomy the distal radius is biconcave,triangular, and covered withhyaline cartilage. Moran, mda,b anatomy and biomechanics of the distal radioulnar joint the ulna is the fixed unit of the forearm joint, with the hand, carpus, and radius rotating around it. No complications or noteworthy correction loss were noted after surgery, even in older patients. Fractures of the distal radius in women aged 50 to 75. Feb 19, 2019 distal radius fractures account for approximately 15% of all fractures in adults. A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Management of malunions of the distal radius request pdf. Opening wedge osteotomy for volarly malunited distal radius fracture restored bony configuration of the distal radius, decreased pain, and improved grip strength and range of wrist motion, particularly for forearm supination. Distal radial fracture radiology reference article. Patients with distal radius fractures will be initially managed on the emergency department. By applying a 1020 angle in the lateral projection, paralleling the articular surface of the distal radius, visualization of the articular surface is improved as a result of normal radial inclination.
Corrective osteotomy of the malunited distal radius fracture. Some patients end up with a delayed operation or a malunited fracture. And postoperatively, the osteotomy was healed, and the patient recovered to full wrist range of motion and without any pain. The purpose was to investigate the relationship between distal radius fracture malunion and armrelated disability. Kgopyane v road accident fund 432352014 2016 zagpphc 872. The initial treatment of fracture distal radius is also play an important role in malunion such as closed reduction with casting which represent more than 81% of the total cases included in this. The muscle belly of the flexor pollicis longus is retracted ulnarly to expose the pronator quadratus, which is elevated from its insertion on the radius fig. Distal radius fractures a free powerpoint ppt presentation displayed as a flash slide show on id. Longterm outcome after a surgically treated distal radius fracture external or internal.
Ppt distal radius fractures powerpoint presentation free. Note the dorsal posture of the lunate and the increases in the scapholunate angle and the capitolunate angle. Ulnar shortening osteotomies leave the radius angular deformities unchanged, risking secondary druj osteoarthritis. Jan, 2011 distal radius fracture is a common injury and may result in substantial dysfunction and pain. Fracture malunion orthopaedic surgery michigan medicine. Malunion is a major complication of fractures involving the distal radius and ulna, seen in up to 33% of cases.
Some examples of common upper extremity fractures that may result in malunion include the distal radius i. Pdf anterolateral surgical approach to the malunited distal. Pdf opening wedge osteotomy for distal radius malunion. Malunion is a recognized cause of suboptimal function after distal radius fracture. In group 1 n 14, patients refused to receive any form of synthetic graft, allograft, or autograft. Dr vikas gupta malunited distal radius fractures olwa 2018 duration. Do young patients with malunited fractures of the distal. After a severe trauma, a 16yearold female patient sustained multiple injuries, including a distal radius fracture of the left arm. Best approaches in distal radius fracture malunions. Acute dislocations of the distal radioulnar joint and distal. Patients will be included if closed reduction of the distal radius fracture is not necessary according to these criteria for. In this case, we demonstrate our preoperative lowcost workup for threedimensional 3d planned and assisted corrective osteotomy of a malunited distal radius fracture using an inhospital 3d printer. The most common deformity following a malunited extraarticular fracture of the distal radius is the loss of the normal palmar tilt of the articular surface in the sagittal plane, and loss of length relative to the ulna.
Sep 24, 2017 malunited distal radius fractures ortho tube. In many cases, when a fracture heals in a position that interferes with use of the involved limb, surgery can be performed to correct it. Malunion remains a common complication in the treatment of distal radius fractures. Modality of treatment for the distal end radius fracture. Many papers have been written about them, with more than 200 having been published in the first 6 months of 2018 alone. Traditional percutaneous kirschner wires kwire and open reduction with volar locking plate vlp are the two most common surgical fixation techniques used to manage dddrf. The objective findings and subjective complaints of a symptomatic malunion. Out of the total number of cases n412 for fracture distal end radius, 5012% cases were managed with cast, 9122%with percutaneous fixation with kwire, 98 with external fixature, 78. The conditions responsible for limited forearm rotation are incongruity, impaction, and stiffness caused by palmar capsular contracture and instability of the druj. Distal radial fractures are a heterogeneous group of fractures that occur at the distal radius and are the dominant fracture type at the wrist. Distal radius fractures are the most common long bone fracture. Malunion is the most common complication of the distal radial bone fracture and results in pain and reduced hand strength and function 2, 3, 21, 22.
Relationship between distal radius fracture malunion and arm. Ulnar shortening osteotomy for malunited distal radius. Pdf treatment of neglected malunion of the distal radius. Malunion is a major complication of fractures involving the distal radius and ulna 3, seen in up to 33% of cases 4. A less invasive distal osteotomy of the radius for malunited dorsally. A thorough understanding of the pathophysiology and treatment of distal radius fractures is important because these injuries are not limited to just the elderly population. Surgical correction of malunited fractures of the distal radius. Two groups of agematched patients were identified, with dorsally angled malunited extraarticular fractures of the distal radius, who underwent openingwedge corrective osteotomy with volar locked plating. Volar plate fixation of distal radius fractures jorge orbay, md miami hand center, 8905 southwest 87 avenue, suite 100, miami, fl 33176, usa reliable internal. Similar to a malunited distal radial fracture, an ununited fracture of the distal radius commonly is associated with residual derangement of the distal radioulnar joint druj. This is often because good reduction is accepted without considering whether the fracture may be so unstable that it will move toward the position of initial injury. Review article recent developments of 3dprinting technique.
The full text of this article is available in pdf format. Distal radius fractures account for 75% of all forearm fractures. Aug 06, 2018 distal radius fractures drf are common injuries. Distal radius fractures account for 75% of all forearm fractures 1, 2. Opening wedge osteotomy for volarly malunited distal radius fracture restored bony configuration of the distal radius, decreased pain, and improved grip strength and range of wrist motion. Different modalities of distal end radius fracture treatment. In the other hand, unstable fracture easily becomes malunited with inadequate treatment.
This can be altered with fracture of the distal radius 15, 17. Modality of treatment for the distal end radius fracture dr bhuvnesh chaturvedi, dr sk irfan ali, dr sumit krishna abstract fracture of the distal end of radius is one of the most common fractures. It occurs in middle aged and elderly women commonly. Surgical correction of malunited fractures of the distal. In the case of malunited fracture, particularly in younger and more active patients with no arthritic changes, openwedge corrective osteotomy with bone autograft is indicated 1, 10, 16, 17, 19, 20.