OPEN REDUCTION AND INTERNAL FIXATION WITH CORTICOCANCELLOUS BONE GRAFT FOR TREATMENT OF VOLARY MALUNITED FRACTURE OF DISTAL RADIUS
Falih Waheed Hashim MB,ChB, FICMS Orthopedics, Lecturer, Department of Surgery, College of Medicine, University of Basrah, IRAQ.
Abstract Malunion of the distal radius is actually a late complication, not salvageable by re-manipulation or a change of immobilization, it requires different management technique. The aim of this study is to choose a technique that corrects the deformity as much as possible, with less complications. An assessment was done for 24 patients with unilateral malunited fractures of the distal radius. The mean age was 42 years (range 25-61 years). They were treated by open-wedge volar osteotomy with corticocancellous graft from upper tibia. Both osteotomy and graft were fixed by volarly applied plate and screws. Preoperative antero-posterior and lateral wrist radiographs were obtained and fracture pattern and radio-carpal alignment were assessed. Radial length and palmar tilt were also measured. The clinical outcome was assessed depending on the modified Gartland and Werley score. Radiological assessment of the parameters was done postoperatively to detect how much these parameters were corrected. This study shows that volar open-wedge osteotomy with corticoocancellous bone graft and internal fixation is a method for correction of malunited distal radial fractures with encouraging results. About 90% of the patients were satisfied with their results regarding the correction of the deformity and improvement of wrist and hand function, as well as limited complications when it is done carefully with appropriate facilities. In conclusion, the corrective osteotomy should be considered only when there is a clear-cut indication. It is actually a method to correct the deformity, rather than treatment of symptoms, specially pain.