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A comparison of corrective osteotomies using dorsal and volar fixation for malunited distal radius fractures

International Orthopaedics volume 42, pages 2873–2879 (2018)Cite this article

Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusions

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.

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Funding

This work was supported by JSPS KAKENHI Grant Number JP 15K10442 and by AMED Grant Number 15570777.

Author information

Affiliations

  1. Health and Counseling Center, Osaka University, 17-1, Machikaneyama-cho, Toyonaka, Osaka, 560-0043, Japan

    Kunihiro Oka

  2. Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan

    Kunihiro Oka, Hiroyuki Tanaka, Kiyoshi Okada, Hideki Yoshikawa & Tsuyoshi Murase

  3. Department of Orthopaedic Surgery, Hoshigaoka Medical Center, Japan Community Health Care Organization, 4-8-1 Hoshigaoka, Hirakata, Osaka, 573-8511, Japan

    Toshiyuki Kataoka

Authors
  1. Kunihiro Oka
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  2. Toshiyuki Kataoka
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  3. Hiroyuki Tanaka
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  4. Kiyoshi Okada
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  5. Hideki Yoshikawa
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  6. Tsuyoshi Murase
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Corresponding author

Correspondence to Kunihiro Oka.

Ethics declarations

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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Oka, K., Kataoka, T., Tanaka, H. et al. A comparison of corrective osteotomies using dorsal and volar fixation for malunited distal radius fractures. International Orthopaedics (SICOT) 42, 2873–2879 (2018). https://doi.org/10.1007/s00264-018-3972-1

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  • DOI: https://doi.org/10.1007/s00264-018-3972-1

Keywords

  • Corrective osteotomy
  • Distal radius malunion
  • Three dimensional
  • Dorsal approach
  • Volar approach
  • Computer simulation