Corrective osteotomy for deformity of the distal radius using a volar locking plate

Abstract

Dorsally angulated malunions of the distal radius have historically been corrected with an opening wedge osteotomy fixed with a dorsal plate. Volar locking plates may facilitate a less morbid approach to corrective osteotomies of the wrist. Eight consecutive patients with an average age of 40 years (range, 15-52 years) underwent correction of a distal radius deformity through a volar approach. Clinical follow-up averaged 17.4 months (range, 7-41 months). Preoperative radiographs revealed an average of 24 degrees of dorsal tilt in patients with dorsal deformity. Postoperatively, their average measurement was <3 degrees of volar tilt. Patients were initially ulnar-positive with an average of 4 mm ulnar-positive variance (range, 2-7 mm). This corrected to less than 1 mm postoperatively. Postoperative disabilities of the arm, shoulder, and hand (DASH), SF-12, and Mayo Wrist scores averaged 10.8, 40.5, and 82.5, respectively. There were no nonunions, and no plates required removal. Distal radius deformity can be effectively addressed through a volar approach with the use of a locking plate.

Figure 1

a Preoperative radiographs of a patient with a dorsally angulated malunion of the distal radius. b Postoperative radiographs. At latest follow-up, the patient had near-normal grip strength and range of motion and no pain.

Figure 2

a Preoperative images of a 51-year-old woman with bilateral severe Madelung’s deformity. The patient was a smoker, and after her osteotomy, she was treated with an external bone stimulator. The patient had a Sauve–Kapandji for her DRUJ symptoms as well. b The patient healed her osteotomy and elected to have the same procedure done on her opposite wrist.