A comparison of corrective osteotomies using dorsal and volar fixation for malunited distal radius fractures
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This study aimed to compare clinical results and to restore radiographic parameters of corrective osteotomy for malunited distal radius fracture using a volar locking plate with a dorsal plate.
We retrospectively studied 28 consecutive patients with symptomatic malunited distal radius fractures followed up for more than 12 months who underwent corrective osteotomy with a dorsal buttress plate (n = 9) or a volar locking plate (n = 19). Volar tilt (VT), radial inclination (RI), and ulnar variance (UV) were radiographically evaluated. Clinical examination parameters included pain, wrist and forearm ranges of motion (ROM), grip strength, and Mayo Modified Wrist Score (MMWS).
The volar group had a significantly greater VT undercorrection for − 9.4° than did the dorsal group for − 1.2° (p < 0.001). Major complications requiring plate removal occurred in six of nine patients in the dorsal group and two of 19 patients in the volar group. The complication ratio was significantly greater in the dorsal group than in the volar group (p < 0.05). Improvements in forearm and wrist ROM, grip strength, and MMWS did not differ significantly between groups.
Opening wedge osteotomy of the radius using a volar locking plate is preferable to dorsal buttress fixation in terms of surgical and technical demands and frequency of complications, but VT correction is insufficient. Surgeons should be aware of the mismatch between the plate and the volar surface of the malunited distal radius.
KeywordsCorrective osteotomy Distal radius malunion Three dimensional Dorsal approach Volar approach Computer simulation
This work was supported by JSPS KAKENHI Grant Number JP 15K10442 and by AMED Grant Number 15570777.
Compliance with ethical standards
Each author certifies that his or her institution approved the human protocol for this investigation, all investigations were conducted in conformity with ethical principles of research, and informed consent was obtained from all study participants.ᅟ
Conflict of interest
O.K. received funding in support of this research from the Japan Society for the Promotion of Science (JSPS). T.M. received funding in support of this research from the Japan Agency for Medical Research and Development (AMED). All the other authors have no conflict of interest.
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